The Patient Services Representative is responsible for providing well defined services to patients, providers and caregivers. Team members will work interactively with patients and their healthcare providers to complete enrollment activities, answer basic program inquiries, and help coordinate access to therapies through the patient’s healthcare provider.

Depending on the specific contracted services an associate may perform one or more of the following activities:

• Inbound Phone Queue/General Program Inquires.
• Determination for support programs (Copay, Patient Assistance Program, 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.
• Researches and resolves any claim denials or underpayment of claims.
• Effectively utilizes various means for collecting information using program approved methods, which could include phone, fax, mail, and online methods.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Reports any trends or delays to program management (e.g. billing denials, claim denials, pricing errors, payments, etc.).
• Ensures all program correspondence and communication (phone, fax, mail, etc.) meets quality standards.
• Works with patient, provider or internal shared services to ensure all necessary documentation is received and complete in accordance with program policy.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
• Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.
• Performs related duties as assigned.

• High school diploma or GED required; a bachelor’s degree is preferred.

• Requires a minimum of three (3) years directly related and progressively responsible experience in customer service, medical billing and coding, benefits verification, healthcare, business administration or similar vocations.
• An equivalent combination of education and experience will be considered.

Minimum Skills, Knowledge, and Ability Requirements:

• Strong customer service experience.
• Proficient with Microsoft Office applications, such as Excel, Outlook, and Word.
• Ability to communicate effectively both orally and in writing.
• Ability to build productive internal and external working relationships.
• Strong interpersonal skills.
• Good analytical skills.
• Strong organizational skills and attention to detail.
• General knowledge of the healthcare industry is preferred.
• Developing professional expertise; applies company policies and procedures to resolve a variety of issues.