Exemption Status:

United States of America (Non-Exempt)

$19.80 - $25.50 - $31.19

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary

The Contact Center Specialist provides research support for multiple internal departments including Contact Center, Prior Authorization, Claims, Configuration Services, Pharmacy Network Management, Client Teams, Legal and Accounting.  Provides direct member support through internet email requests, Partners with Business Solutions on the client support team for MedAccess requests, and Sales Force Requests. Supports direct client requests to meet service commitments.  Ensures client requirements are being met by reviewing design set up and claims adjudication.  Provides suggestions to improve workflow processes.  Great follow through skills to ensure deadlines are met in a consistent manner. Managing escalation procedures and improving customer satisfaction through prompt and accurate internal and external coordination.   Document all developments and interactions for positive resolutions.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Act as primary escalation point of contact for CSR’s members, doctors, and pharmacies.   Ability to de-escalate upset callers in an efficient and knowledgeable manner.
• Responsible for coding claims and claims processing in the manner agreed upon by contract with the client and in accordance with company policy and procedures, including regulatory/compliance requirements.  
• Responds to inquiries via several communication channels: high level escalations calls, physicians’ inquiries, and internal employees.
• Determines the correct course of action for problem resolution by extensively researching our internal systems.
• Evaluate and identify claims processing training needs, makes recommendations for enhancements.
• Identifies and keeps records of concerns, grievances, and error trends to develop weekly communications to the CSR’s. Participates in staff meetings, periodic training programs, and other courses that will aid and maintain skills needed to be successful to this role.
• Coordinate written notification to members, physicians and pharmacies following regulatory guidelines for claims that are missing information.
• Creates and monitors Sales Force cases for CS Coordinator queue and Claims queue.
• Responsible for managing claims inbox, customer service inbox, and ops research inbox.
• Keep records of customer interactions and transactions, details of inquiries, complaints, and comments, as well as action taken for audit and appeal purposes.

Supervisory Responsibilities

No supervisory responsibilities

                                   

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of