Clinical Services Representative – Remote

PharmaCentra, LLC•,

8d•$12 - $15•Remote

About The Position

PharmaCentra LLC is seeking a Clinical Services Representative to join their fully remote team. This role is ideal for a healthcare professional who enjoys problem-solving, working with healthcare information, and assisting members, pharmacies, physicians, and clients with issue resolution, all within a remote work environment. The Clinical Services Representative will provide support for clinical inquiries, prescription benefits, pharmacy claims, prior authorization information, and claims-processing issues. Responsibilities include researching issues, communicating solutions, and ensuring accurate documentation while collaborating with members, pharmacies, healthcare providers, clients, and internal team members.

Requirements

Analytical, detail-oriented, solution-focused, and comfortable working with healthcare information and prescription claims.
Strong analytical and problem-solving skills.
Excellent verbal and written communication skills.
Strong customer service and interpersonal skills.
Excellent attention to detail and accuracy.
The ability to research information and determine appropriate next steps.
The ability to multitask and prioritize competing demands.
The ability to work effectively in a fast-paced healthcare contact center environment.
Strong computer and data-entry skills.
The ability to learn and navigate multiple software applications.
Professional judgment and the ability to appropriately escalate issues.
Dependability, accountability, and reliable attendance.
The ability to work independently while contributing effectively as part of a remote team.
Windows 10 or Windows 11, 64-bit computer
Minimum 8 GB RAM
Quad-core processor or better
At least 50 GB of available storage
Second monitor with minimum 1920 × 1080 resolution
USB noise-canceling headset with microphone
Webcam
Keyboard and mouse
Minimum of two USB-A ports
Minimum of one HDMI port
Minimum 50 Mbps download speed
Minimum 50 Mbps upload speed
Reliable internet connection capable of supporting continuous voice communication and required business applications

Nice To Haves

Two-year college degree in a related field.
Two or more years of applicable healthcare, pharmacy, PBM, insurance, claims, or customer service experience.
Pharmacy or pharmacy-benefit experience.
Experience with prescription claims processing or claims adjudication systems.
Experience with prior authorization processes.
Experience supporting members, pharmacies, physicians, or healthcare providers.
Experience in a healthcare contact center or customer support environment.
Knowledge of prescription benefits or pharmacy benefit management.
Experience using Microsoft Word, Excel, PowerPoint, and Outlook.

Responsibilities

Answer and respond to telephone calls, emails, and faxes from members, clients, pharmacies, physicians, and other healthcare professionals.
Provide support for clinical and prescription-benefit inquiries.
Assist Member Care Representatives with clinical questions and escalated member interactions.
Research and troubleshoot prescription claims and claims-processing issues.
Review information within claims adjudication and other applicable systems.
Assist with questions involving prior authorization information and related processes.
Analyze information to identify potential claim-processing issues and determine appropriate next steps.
Communicate issues, trends, and concerns to management or appropriate internal teams.
Accurately document claims, clinical inquiries, prior authorization information, and other customer interactions.
Maintain confidentiality and handle healthcare-related information appropriately.
Use established procedures, resources, and workflows when resolving inquiries.
Communicate professionally and clearly with members, pharmacies, healthcare providers, and clients.
Manage multiple tasks and priorities while maintaining accuracy and service quality.
Participate in required training, coaching, and quality initiatives.
Perform other duties as assigned.