Remote USA
Description
Pinnacle Claims Management, Inc. (PCMI) is an all-inclusive Third Party Administrator (TPA) that offers competitive, affordable health benefits services to self-funded employers. Unlike other TPAs Pinnacle was born from a member-driven organization (Western Growers) and understands our client’s significance as a business partner. We place tremendous value in our relationships by offering TPA, PBM, ACA Compliance, and comprehensive Health Management services all in-house.
Compensation: $39,208 - $55,972 with a rich benefits package that includes profit-sharing.
Job Description Summary
The Patient Care Coordinator reports to the Supervisor, Pharmacy Benefits Management (PBM). The Patient Care Coordinator role is an important contributor in the internal and external services our Pharmacy Benefit Manager (PBM) provides to customers. In this role, the incumbent will function as a subject matter expert in our PBM customer service. This role works directly with members and vendors, and indirectly with clients to achieve our goal of an elevated PBM experience. The incumbent will also be responsible for researching and analyzing data to address operational challenges and Customer Service department issues.
Qualifications
- High school diploma and one (1) to three (3) years of experience in Pharmacy Benefit Management or retail pharmacy practice, preferred.
- Valid Pharmacy Technician Certification Board Certification (PTCB), desirable.
- Intermediate knowledge of prescription benefits and products, and pharmacy claims.
- Patient Care oriented with ability to set priorities and meet required turn-around time frames.
- Excellent written and oral communication skills, as well as interpersonal skills.
- Good skills for project-based tasks.
- Ability to work effectively in a fast-paced environment
- Analytical thinking skills and problem-solving capabilities.
- Good communication and telephone skills with a very clear and concise speaking voice
- Ability to adapt to a constantly changing environment.
- Proficient organizational and time management skills.
- Fluent in English (oral and written) required. Bilingual in Spanish preferred.
- Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
- Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
- Home router with wired Ethernet (wireless connections and hotspots are not permitted).
- A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
- A functioning smoke detector, fire extinguisher, and first aid kit on site.
Duties And Responsibilities
Customer Service
- Ability to respond to a wide variety of member questions via telephone, e-mail and written correspondence regarding prescription drug benefits in a confidential, professional and ethical manner such as confirming Prior authorization status, verifying patient eligibility & pharmacy benefits, and placing overrides for rejected pharmacy prescription claims.
- Assist Benefits Coordinator I & II with coordinating intake and processing Prior Authorization Requests between doctors, patients, and pharmacy.
- Provide support to Benefits Coordinator II with training CSRs to handle customer service inquiries.
- Assist the Benefits Coordinator II in developing policies and procedures for our customer service agents.
- Provide assistance to Benefits Coordinator I & II and Supervisor in resolving all escalations in a timely manner to meet our Service Level Agreements.
- Responsible for the PBM customer service Help Desk for day-to-day tasks. Prior Authorization tickets, after hours voicemails/ emails, customer service e-mails, and direct member reimbursements.
- Provide the Benefit I coordinator support to develop client-facing reporting and communications.
- Responsible for implementing “white glove” customer service expectations for the PBM.
Operations
- Achieve service level targets with our e-mail box, Prior Authorization tickets, organizing documents in the H drive, and other areas of pharmacy operations.
- Utilize creative methods to understand how our customers perceive their interactions with Pinnacle Rx Solutions and the process of getting their medications.
- Provide suggestions and contribute to workflow improvements.
- Contribute to team of highly skilled and talented experts who maintain the current reporting environment and work to continually improve it by delivering operational reporting products, including critical metric reporting, performance dashboards, work-in-progress trackers and forecasting.
- Back-up and assist the Benefits Coordinator I & II in performing process Improvements, reporting and analytics, project management, and quality assurance activities.
Other
- Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
- Focus efforts on quality and quantity of product deliverables as well as resourcing and project management in a fast paced and challenging environment.
- Ensure application compliance while creating an environment for innovation and growth.
- Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
- Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
- Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
- All other duties as assigned.
