Customer Service Specialist

Hy-Vee, Inc.•Omaha, NE

5d•Onsite

About The Position

Amber Specialty Pharmacy is seeking a Patient Care Specialist to join their Operations Department. This role is responsible for day-to-day customer service activities and support for assigned clients and customers. The Patient Care Specialist will handle inbound and outbound patient phone calls, prescription refill reminder calls, document patient interactions, facilitate patient-to-pharmacist consultations, manage patient enrollment, and assist with patient needs and requests, all while providing excellent customer service. The company emphasizes fulfillment in a career where you can make a positive impact on patients with complex and chronic conditions. Amber Specialty Pharmacy is a wholly owned subsidiary of Hy-Vee, Inc., specializing in managing rare and chronic conditions like organ transplant and oncology, providing comprehensive clinical support and patient management.

Requirements

Proficient with MS Excel, Word, and Outlook
Demonstrated ability to meet tight deadlines
Must be detail oriented with a high degree of accuracy
Ability to work with all levels of internal management and staff, as well as outside clients and vendors
Working knowledge of Medicare, Medicaid, and Commercial Insurance related to pharmacy billing, prior authorizations, insurance verification, and medical terminology preferred
Must be knowledgeable in Medicare, Medicaid, Commercial insurance, and renal programs and how they apply to transplant and specialty patients
Knowledgeable in the process of insurance verification and online prescription adjudication
High School Diploma or equivalent
Working knowledge of the healthcare industry
HIPAA trained and /or the ability to work with and protect highly confidential patient and employee information
Must be able to remain in a stationary position up to 90% of the time
The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc., and traverse conferences, meetings, and remote events
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer
The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations
The ability to observe details at close range (within a few feet of the observer)
Must lift and traverse the area to move paper and supplies to use the equipment.
Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.
Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

Nice To Haves

Working knowledge of Medicare, Medicaid, and Commercial Insurance related to pharmacy billing, prior authorizations, insurance verification, and medical terminology
Must be knowledgeable in Medicare, Medicaid, Commercial insurance, and renal programs and how they apply to transplant and specialty patients
Knowledgeable in the process of insurance verification and online prescription adjudication

Responsibilities

Explains all Company programs and services to patients and provider’s office staff, including what to expect with Company specialty services, contents of shipments, and patient rights.
Acts as a liaison between Company, patients, insurance, Pharma, and provider’s offices via phone, fax, and email communications.
Contacts patients to provide onboarding welcome calls, schedule new medication deliveries, confirm demographic and address information, and inform them of any copayment responsibilities.
Enters data requirements into tracking software.
Transfers call to clinical staff for clinical education/assessment activities.
Places monthly refill reminder calls to patients; refers patients to the clinical pharmacist or nurse as needed.
Communicates with patients as needed based on prescription refills and refers any medication or illness-related questions or concerns to a board-licensed healthcare professional, including but not limited to pharmacists, nurses, or supervised pharmacy interns.
Notifies appropriate staff of relevant information gathered during calls to providers or patients that may affect a patient’s disease state, medication regimen or method of funding.
Records and processes orders and/or inquiries received by mail, telephone and/or through direct patient contact.
Provides timely response to patient inquiries by telephone and/or email in an inbound or outbound manner, consistent with service and quality standards.
Maintains documentation of calls to and from patients, caregivers, insurance, providers, and Pharma.
Creates patient activities as a reminder for the following tasks, including, but not limited to, follow-up calls, clinical assessments, referrals to Case Management, initiation of discharge, patient letter mailings, or other reminders as it relates to the patient’s care.
Must maintain the established workflow within the patient care department and adhere to the company/department’s Policy and Procedure manual.
Adheres to all company policies as indicated in the handbook and directives issued by management.
Has reviewed Policy and Procedure manual.