Customer Service Specialist

Hy-Vee, Inc.•Omaha, NE

11d•Onsite

About The Position

The Patient Care Specialist is responsible for day-to-day customer service activities and support for assigned clients and customers. The role handles inbound and outbound patient calls, prescription refill reminders, documentation of patient interactions, patient enrollment, coordination of patient-to-pharmacist consultations, and other patient needs. The specialist provides excellent customer service while helping patients with complex and chronic conditions. The position explains company programs and specialty pharmacy services to patients and provider staff; coordinates communications among the company, patients, insurers, pharmaceutical companies, and providers; and records and processes orders and inquiries. It maintains patient interaction records and task reminders, routes clinical questions to appropriately licensed healthcare professionals, and follows established workflows, policies, and procedures.

Requirements

High school diploma or equivalent.
Working knowledge of the healthcare industry.
HIPAA training and/or the ability to handle and protect highly confidential patient and employee information.
Proficiency with Microsoft Excel, Word, and Outlook.
Demonstrated ability to meet tight deadlines.
Detail-oriented, with a high degree of accuracy.
Ability to work with internal management and staff at all levels, as well as external clients and vendors.
Knowledge of Medicare, Medicaid, commercial insurance, renal programs, and their application to transplant and specialty patients.
Candidates must pass applicable pre-employment drug testing and a background check; health screening may also apply.

Nice To Haves

Working knowledge of Medicare, Medicaid, and commercial insurance as they relate to pharmacy billing, prior authorizations, insurance verification, and medical terminology.
Knowledge of insurance verification and online prescription adjudication.

Responsibilities

Explain company programs and services to patients and provider-office staff, including specialty-service expectations, shipment contents, and patient rights.
Act as a liaison among the company, patients, insurers, pharmaceutical companies, and provider offices through phone, fax, and email.
Make onboarding welcome calls, schedule medication deliveries, confirm patient demographic and address information, and explain copayment responsibilities.
Enter required data into tracking software and transfer calls to clinical staff for clinical education or assessment.
Place monthly prescription refill reminder calls and refer patients to a clinical pharmacist or nurse as needed.
Refer medication- or illness-related questions and concerns to a board-licensed healthcare professional, including pharmacists, nurses, or supervised pharmacy interns.
Notify appropriate staff of information gathered from patient or provider calls that may affect a patient's disease state, medication regimen, or funding method.
Record and process orders and inquiries received by mail, telephone, or direct patient contact.
Respond to patient inquiries by telephone or email in a timely manner and in accordance with service and quality standards.
Document calls involving patients, caregivers, insurers, providers, and pharmaceutical companies.
Create patient activity reminders for follow-up calls, clinical assessments, case-management referrals, discharge initiation, patient letters, and other care-related tasks.
Maintain established patient-care workflows and follow company and department policies and procedures.
Maintain confidentiality of personal, financial, strategic, and proprietary information.