Remote - Payor-Partner Programs Specialist

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    "title": "Remote - Payor-Partner Programs Specialist",
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    "datePosted": "2025-11-25T05:00:00.000Z",
    "description": "<h2>Overview</h2>\n<p><strong>Scope of Responsibilities: </strong>Works under general supervision. Follows standard procedures to accomplish assigned tasks. Assist in orienting and training employees </p>\n<p> </p>\n<p><strong>Job Summary:</strong> Responsible for all aspects related to management of hub services relationships, entering of medication orders, and customer service for patients/providers in a call center environment. </p>\n<h2>Responsibilities</h2>\n<ul>\n <li>Provide direct support and serve as primary point of contact patients of designated third-party payers </li>\n <li>Follow customized patient support service models and programs to meet and exceed client expectations</li>\n <li>Follow established protocol and non-standard service models to provide the highest quality of services to patients</li>\n <li>Serve as subject matter experts on the intricacies of selected payer partner programs and assist patients in ensuring the correct triage and handling</li>\n <li>Responsible for assisting in the implementation of process improvement to ensure a streamlined patient relationship consistent with selected payer specifications. This may include accessing systems such as partner CRMs to investigate patient needs more fully.</li>\n <li>Responsible to receive triage patient calls from general call center for handling.</li>\n <li>Responsible for accurate selecting billing and shipping methods for incoming patient orders and setting up delivery of patient orders as necessary</li>\n <li>Customer service coverage for incoming calls and directing incoming calls to appropriate staff as needed</li>\n <li>Document patient reported information into TherigySTM</li>\n <li>Document and reporting information via McKesson EnterpriseRX</li>\n <li>Document and research plan specific information in partner CRM/tools.</li>\n <li>Provides resolution to customer service issues to ensure member satisfaction</li>\n <li>Work with members to provide resolution to payment related issues on accounts/orders</li>\n <li>Maintain and keep reasonable production as determined by supervisor </li>\n <li>May assist in orienting and training new employees</li>\n <li>Responsible for completing all mandatory and regulatory training programs</li>\n <li>Perform other duties as assigned</li>\n <li>May assist in training new employees</li>\n</ul>\n<h2>Qualifications</h2>\n<p><strong>Job Skill Requirements: </strong></p>\n<ul>\n <li>Broad knowledge of medications, physician orders, and pharmacy systems</li>\n <li>Effective communication skills </li>\n <li>Outstanding customer service skills</li>\n <li>Excellent organization skills</li>\n <li>Ability to multitask and prioritize </li>\n <li>Excellent computer and keyboarding skills</li>\n</ul>\n<p> </p>\n<p><strong>Educational Requirements:</strong></p>\n<ul>\n <li>Minimum: High School Diploma or GED</li>\n <li>Preferred: Pharmacy technician or related certification</li>\n</ul>\n<p> </p>\n<p><strong>Experience:  </strong></p>\n<ul>\n <li>Past experience in a customer service-related field</li>\n <li>Preferred: 6 months experience in a call center environment</li>\n <li>Preferred: 12 months experience as a pharmacy technician</li>\n</ul>\n<p> </p>\n<p><strong><u>Compensation</u></strong></p>\n<p> </p>\n<p>$18.50 - 22.00 per hour</p>\n<p> </p>\n<p>The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience, and education.  </p>\n<p> </p>\n<p>KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state, and federal regulations as it pertains to minimum wage requirements.</p>",
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