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Patient Care Advocate at Express Scripts

Posted in Other 30+ days ago.

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Type: Full Time
Location: Albuquerque, New Mexico





Job Description:

POSITION SUMMARY

Handle Workers Compensation inquiries from injured workers, providers, adjusters, pharmacies and internal/external clients related to workers compensation benefits. Work to research and resolve problems in a timely manner, while assisting with incoming calls. Assist injured workers in understanding and maximizing the use of their pharmacy distribution program. Use computerized system to gather information and respond to questions. Document issues and resolutions in a common database. Escalate issues as necessary.

ESSENTIAL FUNCTIONS

* Handle inbound and outbound injured worker, provider, adjusters, pharmacies and internal/external client calls

* Manage offline claims operations workflows with adjusters, pharmacies, providers and internal/external clients including eligibility, rejections, and authorizations.

* Answer questions related to pharmacy benefits, while maintaining productivity standards and performance guarantees where applicable

* Work with other operational departments to research and resolve mail order and claims issues and respond to members within performance agreement guidelines

* Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns

* Identify and escalate in a prudent manner, concerns received from patients and/or clients so that corrective action can be pursued and expedited to take care of their needs

* Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety

* Other duties as needed

QUALIFICATIONS

* High school diploma or GED required.

* 1 year of relevant experience.

* General PC knowledge including Microsoft Office and Internet.

* Excellent verbal presentation and communication skills.

* Ability to handle challenging customers in a professional manner.

* Ability to adapt in a dynamic work environment.

* Learns quickly, solve problems and make decisions.

* Willingness to work a flexible schedule for peak call times.

ABOUT THE DEPARTMENT

MyMatrixx is a full-service pharmacy benefit management company focused on patient advocacy. By combining clinical expertise and advanced business analytics, myMatrixx simplifies workers compensation claims management while providing safer medication therapy management.

ABOUT EXPRESS SCRIPTS

At Express Scripts, we dare to imagine a better health care system, and we re driven to make it happen. Where some see obstacles, we see possibilities. We re challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all. We have always acted first to take on the toughest challenges.

We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes like no one else can. We believe health care can do more. We are Champions For BetterSM.

Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all..

Express Scripts is an equal opportunity employer/disability/veteran