• Job Description

  Req#: R84185

  Job Description:

  Responsible for expeditious and accurate adjudication of pharmacy claims, and the provision of excellent customer service to all members, employer groups, providers and other departments or teams. To rotate between pharmacy claims and customer service responsibilities.

  External candidates are eligible for a $1500 sign on bonus.

  Job Details:

  • Positions available in office in Meridian, Idaho and/or Murray, Utah.
  • Hours: 7am-9pm

  Job Essentials
  
  Processes and/or communicates multiple types of pharmacy benefits including coordination of benefits, direct member reimbursements, coinsurance benefits and mail order prescriptions.
  Receives incoming calls from members, providers, facilities, employer groups, and other departments. Provides superior customer service that is consistent with policies, company values and quality standards.
  Educates callers on correct use of their plans, including coverage of benefits, utilization, and administrative guidelines, in collaboration with teammates and other departments. Makes exception/empowerment decisions within the established exception policy.
  Consistently demonstrates excellent customer service skills including problem solving, telephone etiquette, and responsiveness to customers.
  Ensures that all department standards and expectations are met pertaining to call statistics, production, documentation, and quality/accuracy.
  Efficiently and quickly addresses and solves problems on phone calls.
  Meet s or exceeds department standards for call time and answered call percentage in relation to the team average.
  Efficiently and accurately enters overrides for pharmacy claims. Meets or exceeds department standards for override audits.
  Meets or exceeds aux code standards for the department.
  When assigned, assists in the payment of claims for both members and pharmacies while maintaining accuracy standards.
  Completes and analyzes specialized reports that are used to ensure timely and accurate claims adjudication.
  Works closely with the operation and pharmacy teams to educate the staff and resolve problems.
  Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy.
  Maintains customer history in member tracking using correct codes and detailed comments.
  
  Minimum Qualifications

  • One year combined experience in any of the following: medical/pharmacy claims processing; health benefit coordination; customer service experience; pharmacy tecnician experience.
  • Experience utilizing word processing software.

  
  Preferred Qualifications

  • Current national Pharmacy Technician certification.
  • Problem solving capabilities, analytical skills, self-motivated, and able to work well under pressure and through frequent interruptions.
  • Demonstrated excellent verbal and written communication skills individually and within groups.
  • Experience with Facets/AWD system.
  • Health care customer service and claims processing experience.

  Additional Benefits

  • Initial new hire training
  • Ongoing development/career progression
  • Flexwork opportunities (work from home/in office)
  • Health and Dental Benefits Eligible
  • 401(k) Retirement Savings (with employer match)
  • Paid Time Off
  • Tuition Reimbursement
  • PEAK Education Assistance
  • Onsite gym access
  • Employee Assistance Program (EAP)
  • Hourly wage pay increase for successful completion of Spanish Speaking Certification
  • Monthly Superior Service Incentive
  • Referral bonus
  • Shift differential
  • Employee Wellness Program Incentive

  Physical Requirements:

  Manual dexterity, hearing, seeing, speaking.

  Anticipated job posting close date:

  01/01/2024

  Location:

  SelectHealth - Idaho, SelectHealth - Murray

  Work City:

  Meridian

  Work State:

  Idaho

  Scheduled Weekly Hours:

  40

  The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

  $19.53 - $29.76

  We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

  Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion .

  Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

  
  

• About the company

  Intermountain Healthcare is a not-for-profit healthcare system and is the largest healthcare provider in the Intermountain West of the United States.

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