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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service within the healthcare industry, with a strong focus on insurance benefit verification, prior authorizations, and effective communication with patients and healthcare providers. Proficient in managing multiple priorities while maintaining accurate documentation and adhering to quality standards.
Highest-signal resume keywords
Customer Service ExcellenceInsurance Benefit VerificationPrior Authorization ManagementHealthcare Industry KnowledgeAnalytical Problem-Solving
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance Claims ProcessingMedical TerminologyThird-Party BillingCoding KnowledgeDatabase Management
Soft Skills
Excellent Communication SkillsDetail OrientedPatienceAdaptabilityProblem-Solving
Tools & Technologies
MS Office Applications
Industry Keywords
PBMHealthcareCall CenterPatient AccountingReimbursement
About the role
Key responsibilities & impact- Provide the highest quality of customer service to patients and client representatives
- Acquire in-depth knowledge of client and marketing requirements
- Complete verification of benefits and eligibility for referrals from patients, medical doctor’s offices, health plans and pharmaceutical manufacturers
- Investigate benefits and eligibility by phone and/or internet to determine patients’ coverage choices for starting therapy
- Review incoming referrals for completeness and confirm FDA requirements are met as applicable
- Answer incoming calls quickly and efficiently, evaluating needs and responding or routing calls to the appropriate team member
- Assist with reimbursement inquiries, including insurance benefit verification, prior authorization, denials, appeals and other reimbursement issues
- Provide billing and coding information related to specific products as needed
- Conduct general payer research
- Participate in call center activities and triage incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies and homecare agencies
- Serve as a single point of contact for an assigned group of prescribers as needed
- Manage action item lists and ensure tasks are completed in a timely manner
- Maintain accurate and complete documentation of inquiries
- Identify and escalate repetitive questions or problems for corrective action
- Adhere to housekeeping techniques, quality and production standards, and applicable safety and environmental procedures
- Perform other duties as assigned
Requirements
What you’ll need- High School diploma or equivalent
- 3-5 years’ experience in a customer service setting, preferably in a call center environment
- Previous experience in the PBM and or Healthcare Industry preferred
- Computer proficiency in MS Office applications, with database experience preferred
- Health insurance claims or patient accounting experience preferred
- Knowledge of third-party billing, coding, medical terminology, prior authorizations and appeals preferred
- Detail oriented with good analytical skills
- Ability to manage multiple priorities and meet deadlines
- Excellent written and verbal communication skills, demonstrated ability to communicate with others at all levels
- Excellent customer skills—patience to explain details and processes repeatedly, excellent phone presentation skills
- Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
- Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
- Ability to work a flexible schedule
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match*
- Tuition reimbursement
- Flexible work environment
- 20 days PTO, accrued
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine(Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs