LucyRx

Operations

• Manage texts, service emails, incoming calls, and voicemail
• Serve as an escalation point for Helpdesk issues and resolve calls and questions not handled by Helpdesk agents
• Maintain and update Helpdesk instructions and protocols
• Respond to prior authorization status inquiries from providers and partner vendors
• Resolve member coverage, cost, card, and prior authorization clinical criteria inquiries
• Print and mail prior authorization denial letters
• Assist members with portal registration and claims viewing for dependents
• Enter rejection overrides and assist pharmacies with claim adjudication
• Review and triage prior authorization tickets, remove duplicates, and archive inactive or aged tickets
• Update provider fax information and resend prior authorization forms or decision faxes
• Coordinate data collection for new accounts and renewals
• Prepare implementation, plan change, legal, account structure, and drug/product list documents
• Run claims testing to validate configuration accuracy
• Attend weekly client meetings and track open issues
• Maintain portal access, invoice, report, and rebate recipient records
• Conduct portal tutorials and resolve report discrepancies
• Create client-facing lists and collateral with the Marketing team
• Provide census files and member contact information to partners and vendors
• Send prior authorization approval and rejection summaries to partners and vendors
• Notify clients and agents of formulary changes and member impacts
• Review invoices, complete clinical reports, and create custom reports
• Review reimbursement requests and disputed claims for eligibility and programming accuracy
• Investigate accumulator discrepancies and eligibility file issues
• Submit eligibility corrections and refund reports to the appropriate teams

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Client Operations Specialist