Contact Center Specialist I

MedImpact Healthcare Systems, Inc.•San Diego, CA

11d•$20 - $31•Onsite

About The Position

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! 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.

Requirements

GED/HS Diploma and 2+ years’ experience or equivalent combination of education and experience
Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs. Experience with Windows based SharePoint and database programs is also required.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's.
Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of organization.
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.

Nice To Haves

Current Pharmacy Technician License or National CPhT certification without restriction preferred.

Responsibilities

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.