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Clinical - Exception Template

Axelon Services Corporation
Full-time
On-site
New York City, NY
Location: Remote, not state specific but EST time zone is preferred to start. SHIFT: Monday to Friday. Between 8 AM & 6 PM EST Saturday: 1 2 days on rotation basis -might be involved as the program evolves. Subject to change and have flexibility. Duration: 12 months, possible conversion Position Purpose: The purpose of this team is to assist with coordination of healthcare personnel administered drug services at preferred sites of care. Goal is to provide seamless member & provider services. Walk me through the day-to-day responsibilities and a description of the project : * Staff will log into phone queue, answer calls from providers, retrieve voicemails, and review reports for any provider & member follow-up calls that need to be conducted. * Team members will review prior authorizations to confirm the site of care is appropriate and redirect members to alternative servicing providers when needed based on policy. * This will require phone outreach to providers and members. * Performance expectations will be based on the quality of customer services to members & providers, site of care review process, and number of successful contacts. * Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider physician injectable claims issues. Perform training, orientation and coaching for performance improvement within physician practices. * Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome. Education/Experience: Bachelor s degree in Healthcare related field preferred. 3 years of combined public relations and pharmacy related experience. Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred. License/Certification: Valid driver s license. CPhT license preferred. * Candidate Requirements * * Education/Certification * Required: High School Diploma or equivalent Preferred: Bachelor s degree in healthcare related field. * Licensure * Required: N/A Preferred: Current state s Certified Pharmacy Technician (CPhT) license Years of experience required: 3 years of experience in healthcare Disqualifiers: Additional qualities to look for: Knowledge of health care, managed care, Medicare or Medicaid preferred. Claims billing/coding knowledge preferred. Customer service experience