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Client Services Representative I
2 months ago
Client Services Specialist I
Location:
Fully remote
Job Overview:
The Client Services Specialist I is responsible for managing inbound communications from healthcare providers, pharmacies, and members, delivering professional and courteous assistance throughout the prior authorization process.
This role requires meticulous documentation of all interactions and reviews, ensuring that all clinical inquiries and escalations are directed to the appropriate pharmacist team.
The Specialist will also engage in various tasks as assigned, including outbound communications, processing prior authorizations received through various channels, and addressing inquiries through departmental mailboxes.
Collaboration with healthcare providers is essential to effectively process prior authorization and drug benefit exception requests, adhering to Medicare Part D CMS Regulations.
Key responsibilities include:
- Utilizing multiple software systems to conduct Medicare appeals case reviews.
- Meeting or exceeding established timelines mandated by regulatory bodies.
- Communicating resolutions to beneficiaries or providers through direct interactions and professional correspondence.
- Maintaining up-to-date knowledge of relevant Medicare guidance.
- Managing work volume efficiently by handling incoming calls and requests with professionalism.
- Ensuring compliance with departmental, company, state, and federal regulations while processing information.
- Coordinating with internal teams regarding determination statuses and results.
- Identifying and escalating clinical inquiries to the pharmacist team as necessary.
Qualifications:
0-3 years of experience in a customer service or call center setting, managing a high volume of calls daily.
Preferred experience includes six months in a PBM or pharmaceutical environment.
A minimum of two years in a general business role involving problem resolution, business writing, quality improvement, and customer service is also desired.
Skills Required:
- Prior Authorization
- Knowledge of Medicare and Medicaid
Education:
High School diploma or GED is required.
About US Tech Solutions:
US Tech Solutions is a global staffing firm offering a diverse range of talent on-demand and comprehensive workforce solutions.
We are an Equal Opportunity Employer, ensuring that all qualified applicants receive consideration for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
