• Patient Benefit Specialist

    KPH Healthcare Services, Inc. (Flowood, MS)


    Overview

    **Scope of Responsibilities:** Works under general supervision. Follows standard procedures to accomplish assigned tasks. May assist in orienting and training employees

    **Job Summary:** Responsible for all aspects related to adjudication and billing of specialty prescriptions in a call center environment.

    Responsibilities

    Job Duties:

    + Responsible for monitoring adjudication queue(s)

    + Responsible for contacting members and prescribers on non-covered items

    + Facilitate prior authorization process for customers

    + Provide clinical services in TherigySTM

    + Customer service coverage for incoming calls and directing incoming calls

    + Provides resolution to customer service issues to ensure member satisfaction

    + Work with members to provide resolution to payment related issues on accounts/orders

    + Maintain and keep reasonable production as determined by supervisor

    + May assist in orienting and training new employees

    + Responsible for completing all mandatory and regulatory training programs

    + Perform other duties as assigned

    Qualifications

    Attendance Requirements:

    + Must be available, and on-time for scheduled work shifts.

    + Must be able to work nights and weekends as required.

    Educational Requirements:

    + Minimum: High School Diploma or GED

    + Preferred: Pharmacy technician or related certification

    Experience:

    + Past experience in a customer service related field

    + 6-12 months experience as a pharmacy technician

    Special Conditions of Employment:

    + Drug test

    + Initial and continuous exclusion and sanction/disciplinary monitoring

    + Any and all additional eligibility requirements based on the specific position

    Job Skill Requirements:

    + Broad knowledge of medications, physician orders, and pharmacy systems

    + Familiar with Enterprise billing options and practices surrounding claim submission

    + Strong communication skills

    + Outstanding customer service skills

    + Excellent organization skills

    + Ability to multitask and prioritize

    + Excellent computer and keyboarding skills

    + Successful completion of a pre-employment and/or random drug screening test

    Required Training:

    + HIPPA Privacy Course

    + HIPPA Security Course

    + Fraud, Waste, and Abuse Course

    + MethGuard Course

    + HIPPA Privacy CE Mastery Exam

    + HIPPA Security CE Mastery Exam

    + Fraud, Waste, and Abuse CE Mastery Exam

    + MethGuard CE Mastery Exam

    Behavioral Traits Required:

    + Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and others you are in contact with

    + Initiative: Must work within supervision guidelines and assume additional responsibilities

    + Flexibility: Must be willing to work variable work schedules, nights and weekends, assist others as requested and available, and be willing to perform all assigned work

    + Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences

    + Involvement: Must enjoy the demands of the job and work with interest and enthusiasm

    + Customer Service: Must provide superior customer service (for Noble customers, fellow employees and business partners), listen attentively to their needs and respond appropriately

    + Safety: Must take care of equipment and employ good safety habits

    + Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams

     

    Compensation

     

    $17.50-19.37 per hour.

     

    The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience,and education.

     

    KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state** **,** **and federal regulations as it pertains to minimum wage requirements** **.

     

    Connect With Us! (https://kphcareers-kphhealthcareservices.icims.com/jobs/13945/patient-benefit-specialist/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336031866)

     

    **Job Locations** _US-MS-Flowood_

    **Posted Date** _3 months ago_ _(3/18/2025 12:35 PM)_

    **_Requisition ID_** _2025-13945_

    **_\# of Openings_** _1_

    **_Category_** _Customer Service/Support_

    **_Location : Location_** _US-MS-Flowood_