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Prior Authorizations Specialist - Healthcare Call Center

Company Name: Kroger Specialty Pharmacy
Position Type: Employee
FLSA Status: N/A

 

 

Position Summary

Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice. Demonstrate the companys core values of respect, honesty, integrity, diversity, inclusion, and safety.

Essential Job Functions

  • Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards
  • Investigate and verify benefits for pharmacy and medical third-party claims for assigned cases
  • Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed
  • Review for accuracy of prescribed treatment regimen prior to submission of authorization
  • Facilitate appeals process between the patient, physician and insurance company; compose clinical appeals letters based off of specific denial reason and patients clinical presentation and coordinate appointment of representative document
  • Complete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off of eligibility and specific drug prescribed
  • Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service
  • Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions)
  • Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacy
  • Complete a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when required
  • Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records
  • Ensure that work activities are conducted in compliance with regulatory requirements and the organizations defined standards and procedures, and in a manner that provides the best available level of service and quality
  • Perform or assist with any operations, as required to maintain workflow and to meet business needs
  • Perform other related duties as assigned
  • Must be able to perform the essential job functions of this position with or without reasonable accommodation
  • Minimum Position Qualifications

  • High School Diploma or GED
  • 1 year of proven work experience in a healthcare or customer service industry
  • Superior telephone customer service skills
  • Strong organization skills as well as attention to detail
  • Excellent knowledge of insurance benefit investigation process and techniques
  • Demonstrated ability to manage a range of priorities and meet time commitments
  • Excellent data management software skills with demonstrated adaptability to internal systems
  • Demonstrated strength in listening, oral and written communications in English
  • Desired Previous Experience/Education

  • Pharmacy Technician Certification
  • Any additional training in pharmacy/medical benefit access and requirements
  • Any healthcare experience with a basic understanding of clinical terms and benefits investigation
  • Any previous experience in a call center preferred where performance was measured
  •  

    Education Level: High School Diploma/ GED Required
    Required Travel: None
    Required Certifications/Licenses: None
    Position Type: Full-Time

    Regions: Any


     

    Jobs at Kroger: At Kroger, we hire people who have a passion for helping others and who want to build a relationship with our Customers. No matter what stage of your career, you can build your future at Kroger. We look for people who want more, aspire to be more and work hard to achieve their goals. Our focus on keeping the Customer first is what makes us successful. We offer many opportunities not only in our stores, but in Manufacturing, Logistics, Marketing, Finance, Human Resources, and many other fields.
     

    Company Overview: Kroger Family of Companies employs nearly half a million associates who serve over 11 million customers daily through a seamless shopping experience under a variety of banner names.  At The Kroger Co., we are Fresh for Everyone™ and dedicated to our Purpose: To Feed the Human Spirit®.  We are committed to creating #ZeroHungerZeroWaste communities by 2025.  Careers with The Kroger Co. and our family of companies offer competitive wages, flexible schedules, benefits and room for advancement.

     

     Posting Notes:  LA || Harvey || 2731 Manhatten Blvd #B17 || 70058 || Kroger Specialty Pharmacy || None || Call Center; Health & Wellness; Pharmacy; Specialty Pharmacy || Employee || Non-Exempt || Full-Time || None 


    Nearest Major Market: New Orleans

    Job Segment: Medical, Call Center, Pharmacy, Law, Developer, Healthcare, Customer Service, Legal, Technology

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