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Clinical Care Specialist
1 month ago
Job Summary
TrueScripts Limited is seeking a highly skilled Clinical Care Representative to join our team. As a Clinical Care Representative, you will be responsible for performing all clinical tasks relative to in-house and external communications with clients, members, pharmacies, and physicians. This role responds to clinical inquiries, prior authorization requests, and paper claims requests, analyzes data, assists members with prescription benefits, and problem-solves in the claims system. Additional responsibilities include logging and preparing client invoices and providing administrative support to management.
Key Responsibilities
Account Inquiries & Claims Processing: Receive phone calls/emails/faxes from members, clients, pharmacies, and/or physician offices. Assist Member Care Representatives with clinical calls. Troubleshoot claim processing problems and/or inquiries in the claims adjudication system. Respond to website inquiries. Complete Prior Authorization requests. Become proficient in all aspects of the claims adjudication system. Communicates problems and concerns to the manager.
Consulting Services Support
Work with Rx data in Excel and/or TrueScripts dashboard. Reach out to members to assist in a change of Rx to a more cost-effective generic alternative. Provide members with co-pay assistance for brand and specialty medications. Act as patient advocates when excluded medications are identified - communicate effectively with all parties involved.
Claims Logging, Invoicing & Reporting
Log Specialty Care, Brand Care, Paper Claims, and Fee for Prior Authorizations on SharePoint. Log Specialty and Non-Specialty Prior Authorization approvals on SharePoint. Prepare and send weekly/monthly invoices to the Accounting team. Document actions and outcomes in the client database.
Administrative Support
Identify process/procedure improvements and update documents on SharePoint. Schedule meetings/conference calls as requested. Assist with creating/updating marketing materials in Publisher/Word. Assist Data Analytics team with report preparation for client annual reviews in Excel.
Requirements
Education: Associate degree - related field preferred, but not required. Licenses and Certification: Active pharmacy technician preferred, but not required. We are looking for someone with two years of applicable experience and strong analytical thinking and attention to detail. Excellent communication and customer relations skills are also essential. Ability to multi-task and prioritize in an ever-changing environment is a must. Strong computer skills including Microsoft Office (Excel, Word, PowerPoint, Outlook) are required.
