Field inbound inquiries from benefit professionals, health care facilitators as a member of the broader client account team
Research and analyze electronic and manual claims.
Apply troubleshooting skills to resolve issues as allowed by the individual benefit, including entering and updating MPAs and submitting test claims
Communicate prior authorization, exception, and appeals information to callers including required information, turn-around-times, and other applicable details
Help educate, when appropriate, members how to navigate their benefit, including information regarding participating pharmacies, best utilization of their benefit, formulary explanations, patient pay amounts, benefit restrictions, and other information as applicable
Documents and tracks status of inquiries and resolution in both NCRx and CRM
Respond to and resolve all internal and external inquiries in a timely, accurate, and complete manner
Protect all personal health information and abide by all HIPAA regulations and confidentiality requirements
Other duties as assigned.

A minimum of a high school degree or equivalent is required
National Certification from an accredited pharmacy technician certification program approved by specific state regulations (e.g. PTCB, ExCPT, CPhT etc.). or Licensed Practical Nurse (LPN) degree or certificate preferred
5+ Years’ previous experience working with members/patients
Experience in a mail pharmacy, retail pharmacy or clinic/care setting desired
Experience as a member of a multi-disciplinary team is preferred
Knowledge of applicable data privacy practices and laws is preferred
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees.

Client Advocate

Key skills