Customer Service Specialist
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Mount Prospect, IL 60056
Client Position Title: Intake Agent
Position Number: 329009
Location: Mount Prospect, IL 60056
Required Skill Set:
CMS, Customer Service, Technician
Position Description:C2C is not available
Only U.S. Citizens and those authorized to work in the U.S. can be considered as W2 candidates.
Title: Intake Agent
Location: Mount Prospect, Illinois USA 60056
Duration: 6 Months
• The Intake Agent – Prior Authorization is responsible for the efficient, accurate and timely prioritization and management of work. Provides support to the Prior Authorization Department in meeting client expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making. Responsible for maintaining compliance with ERISA, CMS, and client specific requirements. Works as part of the team to meet business unit objectives. This position is also responsible for receiving calls from physician offices and providing professional and courteous assistance to all callers through the criteria-based process. The Intake Agent will follow criteria question set prompts to facilitate system-generated approvals. Further responsibilities include maintaining complete, timely, and accurate documentation of all requests, communicating to the physician’s office, pharmacies, intake etc. as needed, and transfers all clinical questions and judgement calls to the Pharmacy Technician or Clinical Pharmacist as needed. The Intake Agent will also assist with other duties such as outbound calls, monitoring/responding to inquiries in mailboxes and other duties as assigned by the leadership team. The Intake Agent will support requirements of the PA team by working as part of a weekend coverage team on a rotating basis where needed.
• No tech license required
• Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards. Sort incoming faxes in compliance with departmental and client requirements.
• Manage case load of for all clients by researching and triaging incoming fax requests. Use adjudication systems to identify the type of request and create, route, and/or complete appeals or requests in accordance with department processes. Process External Review appeal requests according to federal, client, and state mandated guidelines.
• Act as a subject matter expert and assists with Coordinator duties dependent upon business needs. Provides support/mentoring to Coordinator staff to solve case processing questions and issues.
• Seek guidance and collaborate with Pharmacy Technicians, Pharmacists, and other internal partners for timely resolution of issues with case processing.
• Works closely with internal partners to develop work instructions and promote process improvements.
• Other duties assigned.
• Excellent customer service skills with the ability to effectively interact with physicians, physician office staff and a diverse customer base
• Must be able to communicate articulately and comprehend oral, written and verbal communications
• Basic level of keyboarding skills
• Strong working knowledge of PC and windows-based applications (i.e. start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, opening a browser, access information on-line, etc.)
• Must be capable of pronouncing drug names and diagnosis and recognizing medical terminology
• Ability to maintain patient confidentiality and confidentiality of information
• Ability to calculate and perform basic mathematical calculations (i.e. addition, subtraction, multiplication, division)
• Ability to handle multiple tasks and utilize multiple computerized information systems
• Essential skills in navigating a software system to document conversations and outcomes
• Ability to perform work in an organized fashion with focus on complete information and time related deadlines
• Ability to effectively manage calls and off-line intake functions
• Ability to work with people in a team environment while meeting individual performance goals
Mandatory overtime requirements
NOTE: The job does not require a license. Offers made to qualified resumes.
• HS diploma or equivalent required
• Associate’s or Bachelor’s degree preferred
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.)