Customer Care Associate
Middletown RI 02842
Job DescriptionThis position is a front-line service position providing assistance to Magellan's members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.
- Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
- Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
- Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- Assists in the mentoring and training of new staff.
- Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
- Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
- Educates providers on how to submit claims and when/where to submit a treatment plan.
- Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
- Informs providers and members on Magellan's appeal process.
- Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.
- Links or makes routine referrals and triage decisions not requiring clinical judgment.
- Performs necessary follow-up tasks to ensure member or provider needs are completely met.
- Provides information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.
- Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
- Refers patients/EAP clients to the Magellan's Care Management team for a provider, EAP affiliate, or Facility.
- Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
- Support team members and participate in team activities to help build a high-performance team.
- Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
General Job Information
TitleCustomer Care Associate
Job FamilyCustomer Service Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date11/25/2019
Date Requisition Created11/21/2019
EducationGED (Required), High School (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
-CPT: Certification/licensure in accordance with state requirements. In the states of Florida and Michigan, license registration with the Board of Pharmacy is required without exception.
-PTCB: Certification or the ability to obtain PTCB Certification within one year of hire. Employees in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the PTCB.
-Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
-In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
-Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
-Excellent written and verbal communication skills.
-Ability to follow clinical criteria and instructions to approve prior authorization requests.
-Minimum 2 years dispensing or retail experience required, or equivalent internal training will be substituted.
-Ability to identify and trouble-shoot problematic issues.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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