Location: Cincinnati, US-OH
Rate: Not Specified
Type: Permanent
KPP/PATIENT CARE COORDINATOR
Coordinate all incoming prior authorizations and appeals via, phone, fax, or email to meet the needs of the department.
Responsible for verifying/obtaining clinical information to complete the prior authorizations and/or appeals.
Handle member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution.
Provide knowledgeable and courteous customer service to members and providers.
Use the electronic pharmacy system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist.
Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.Minimum
- High School Diploma or GED
- State or National Pharmacy Technician Registration/Certification
- Proficient in Microsoft Office
- Self-motivated with the ability to plan and meet deadlines
- Excellent administrative, communication, and organizational skill with high attention to detail
- Demonstrated ability to maintain confidentiality and protect sensitive information
- Strong time management skills
- Ability to prioritize/multi-task while providing accurate/on-time results
- Familiarity with industry/technical terms and processes
Desired
- Any prior pharmacy experience and/or PBM experience
- Any previous administrative support or direct customer service experience- Manage the organization and expectations of the prior authorizations and appeal process, including submitting details to pharmacists for review, ensuring reviews are complete and communicating decisions to interested parties
- Support patient experience through patient-centered communications demonstrating excellent customer service skills
- Manage correspondence with patients, physicians, vendors, and internal customers as required including outbound and inbound telephone calls
- Collaborate with other departments and vendors to assist in with prior authorizations/appeals
- Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed
- Participate in problem identification and coordinate resolution between appropriate parties
- Develop and analyze spreadsheet data to assist with managing record keeping, creating reports, etc.
- Assist clients and pharmacies with troubleshooting claims and resolution of day-to-day client issues
- Perform other duties as assigned
- Must be able to perform the essential job functions of this position with or without reasonable accommodation
Rate: Not Specified
Location: Cincinnati, US-OH
Type: Permanent
Industry: Finance
Recruiter: Kroger Health & Wellness
Contact: Not Specified
Email: to view click here
Reference: 105301
Posted: 2025-05-17 08:19:05 -
Rate: Not Specified
Type: Permanent
KPP/PATIENT CARE COORDINATOR
Coordinate all incoming prior authorizations and appeals via, phone, fax, or email to meet the needs of the department.
Responsible for verifying/obtaining clinical information to complete the prior authorizations and/or appeals.
Handle member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution.
Provide knowledgeable and courteous customer service to members and providers.
Use the electronic pharmacy system to facilitate prior authorizations and participate in patient/provider/customer care activities that do not require the expertise of a pharmacist.
Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.Minimum
- High School Diploma or GED
- State or National Pharmacy Technician Registration/Certification
- Proficient in Microsoft Office
- Self-motivated with the ability to plan and meet deadlines
- Excellent administrative, communication, and organizational skill with high attention to detail
- Demonstrated ability to maintain confidentiality and protect sensitive information
- Strong time management skills
- Ability to prioritize/multi-task while providing accurate/on-time results
- Familiarity with industry/technical terms and processes
Desired
- Any prior pharmacy experience and/or PBM experience
- Any previous administrative support or direct customer service experience- Manage the organization and expectations of the prior authorizations and appeal process, including submitting details to pharmacists for review, ensuring reviews are complete and communicating decisions to interested parties
- Support patient experience through patient-centered communications demonstrating excellent customer service skills
- Manage correspondence with patients, physicians, vendors, and internal customers as required including outbound and inbound telephone calls
- Collaborate with other departments and vendors to assist in with prior authorizations/appeals
- Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed
- Participate in problem identification and coordinate resolution between appropriate parties
- Develop and analyze spreadsheet data to assist with managing record keeping, creating reports, etc.
- Assist clients and pharmacies with troubleshooting claims and resolution of day-to-day client issues
- Perform other duties as assigned
- Must be able to perform the essential job functions of this position with or without reasonable accommodation
Rate: Not Specified
Location: Cincinnati, US-OH
Type: Permanent
Industry: Finance
Recruiter: Kroger Health & Wellness
Contact: Not Specified
Email: to view click here
Reference: 105301
Posted: 2025-05-17 08:19:05 -
Job ID: 477931118
Originally Posted on: 5/21/2025
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