JOB DESCRIPTION
Perform duties to review, translate, and enter prescription data into systems for benefit investigation, prior authorization support, and pharmacist verification working within the limits of standard or accepted practice. Demonstrate the company s core values of respect, honesty, integrity, diversity, inclusion, and safety.
RESPONSIBILITIES
- Review all elements of prescriptions for accuracy, including, but not limited to appropriate signature, date, directions, quantity, and refills
- Perform tasks to process prescriptions in compliance and understanding of the state and federal laws and internal policies and procedures governing the handling, dispensing and distribution of prescriptions
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- Translate and enter prescription data elements required to complete all patient access functions and dispensing
- Transfer or coordinate verbal transfer by a pharmacist of prescription to alternate pharmacy if required
- Respond to inbound calls and triage to appropriate clinician/department if required
- Demonstrate excellent customer service while communicating with patients, prescribers offices, and associates to build business relationships
- Initiate communication with new patients informing them of prescription and welcoming them to KSP
- Obtain and process new prescriptions, clarifications, and refill authorizations from providers offices; obtain patient s medication drug list for DUR investigation
- Review and adjudicate prescription insurance claims of medications to be delivered
- Contact patient, providers office, and insurance companies for appropriate processing of claims
- Investigate and verify benefits for pharmacy and medical third-party claims
- Complete assessments mandated by either manufacturer contracts, operations and facilitates patient enrollment with manufacturer Hubs when required
- Documents case activity, communications, and correspondence in system to ensure completeness and accuracy of patient contact records
- Ensure that work activities are conducted in compliance with regulatory requirements and the organization's defined standards and procedures, and in a manner that provides the best level of service and quality
- Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements
- Participate in meetings to communicate issues, obtain approvals, resolve problems and maintain knowledge of new developments, requirements, and policies
- Perform other related duties assigned
- Must be able to perform the essential job functions of this position with or without reasonable accommodation
QUALIFICATIONS
Minimum
- High School Diploma or GED
- Demonstrated excellence in listening, speaking, and writing skills, with proven ability to communicate clearly and effectively at all levels of the organization
- Clear understanding of healthcare privacy protocols including HIPAA
- Proficiency with pharmacy applications and computer operations with knowledge of MS Office software including Word and Excel
- Consistent focus and attention to detail resulting in superior accuracy
- Demonstrated organizational skills and the ability to problem solve and multitask between data entry and telephonic communication
- Proven skills in customer service and customer relationship building skills
Desired
- 1 year of healthcare/pharmacy customer service experience with knowledge of benefits access and prescription processing
- Demonstrated knowledge of medications utilized for therapy in the defined disease state served by the assigned pharmacy
ABOUT US
\n From one tiny Cincinnati grocery store more than a century ago, we've grown into what today is the nation's largest grocer with nearly 2,800 stores in 35 states operating under 28 different names. As America's grocer, we take pride in bringing diverse teams with a passion for food and people together with one common purpose: To Feed the Human Spirit. With a history of innovation, we work tirelessly to create amazing experiences for our customers, communities AND each other, with food at the heart of it all. \n
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\n Here, people matter. That's why we strive to provide the ingredients you need to create your own recipe for success at work and in life. We help feed your future by providing the value and care you need to grow. If you're caring, purpose-driven and hungry to learn, your potential is unlimited. \n
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\n Whether you're seeking a part-time position or a new career path, we've got a fresh opportunity for you. Apply today to become part of our Kroger family! \n