Job Description:

• Under the general supervision of an Operations Manager, they are considered a master of our services including but not limited to reimbursement activities, claim submission, claim status, collection activity, appeals, patient assistance, and copay assistance.

• On a day-to-day basis they may be in contact with various customers of our services including but not limited to patients, providers, caregivers, and client brand teams.

Roles and Responsibilities:

• Master of all standard and advanced services and willing to perform them as needed for the good of our patients.

• Including but not limited to:

• Billing and coding support

• Claims assistance, tracking, and submission

• Prior authorization assistance and tracking

• Coordination of benefits

• Benefit verification result call

• Welcome calls

• Advanced alternate coverage research

• Appeals/Denials

• Inbound Phone Queue/General Program Inquiries

• Determination for support programs (Copay, PAP, Medicaid, etc.)

• Pharmacy triage and coordination

• Order processing for wholesale orders

• Other follow-up activities (missing info, prior authorization, etc.)

• Intakes and reports adverse events as directed.

• Non-Clinical adherence services

• Engages with manufacturer representatives around items like payer profiles, reimbursement trends, issues with specific offices, etc.

• Responsible for coordination of services with field reimbursement teams and sales representatives.

• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.

• Independently analyzes, reports, resolves, and communicates any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.).

• Processes any necessary correspondence.

• Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within

• Provides training and support to internal associates.

• Fields questions from program representatives and specialists.

• Handles initial customer escalations.

• Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate.

• Independently and effectively resolves complex accounts with minimal supervision.

• Maintains confidentiality in regard to all patient-sensitive information.

• Works on complex issues where analysis of situations or data requires an in-depth evaluation of variable factors. Exercises judgment in selecting methods, techniques, and evaluation criteria for obtaining results. Networks with key contacts outside their own area of expertise.

• Acts independently to determine methods and procedures on new or special assignments.

• Performs related duties and special projects as assigned. 

Must-Have Skills:

• Ability to communicate effectively both orally and in writing.

• Ability to build productive internal/external working relationships.

• Advanced interpersonal skills.

• Strong mathematical skills.

• Basic analytical skills.

• Advanced organizational skills and attention to detail.

• Extensive knowledge of pharmacy operations and medical claims.

• Excellent use of medical industry vernacular.

• General knowledge of health care billing is required. Advanced knowledge is preferred.

• Advanced use of MS Excel, Outlook, and Word.

• Developing professional expertise; applying company policies and procedures to resolve a variety of issues.

Educational Requirements:

• A high school diploma or GED is required.

• Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service, or similar vocations generally obtained through completion of a two-year associate’s degree program, technical vocational training, or equivalent combination of experience and education.

• Five years (5) + years of directly related and progressively responsible experience required.

• A two-year degree can be used in lieu of 2 years of the experience requirement, and a four-year degree in lieu of 4 years of experience.

• Four-year degree preferred.

About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities.

ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.