Clinical Care Representative - Remote - Evansville, Indiana

Job Type
Full-time
Description
Looking for something BETTER? So were we! That's why TrueScripts was created.
But "better" didn't stop there. That's why we're now looking for YOU!
What we're about
TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care.
Did we mention Amazing Care ? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy. And there is a reason that our company was just named the #1 Best Place to Work (for medium-sized employers) in Indiana!
Our team members enjoy:

• Robust benefits and a strong salary
• Employee Assistance Program
• Wellness Program
• Dream Manager Program (yes, it's a real thing!)
• A cohesive, family-based culture
• Charitable contributions
• Lots of celebrations!

*** This position is fully remote if you live in Evansville, Indiana ***
Ok, enough about us. Here's what we need from you:
What you'll do
In a few words
The Clinical Care Representative is responsible for performing all clinical tasks relative to in-house and external communications with TrueScripts clients, members, pharmacies, and physicians. This role responds to clinical inquiries, prior authorization requests, and paper claims requests, analyzes data, assists members with prescription benefits, and problem-solves in the claims system. Additional responsibilities include logging and preparing client invoices and providing administrative support to management.
The fundamentals for the job

• Account Inquiries & Claims Processing
  • Receive phone calls/emails/faxes from members, clients, pharmacies, and/or physician offices.
  • Assist Member Care Representatives with clinical calls
  • Troubleshoot claim processing problems and/or inquiries in the claims adjudication system
  • Respond to website inquiries
  • Complete Prior Authorization requests
  • Become proficient in all aspects of the claims adjudication system
  • Communicates problems and concerns to the manager
• Consulting Services Support
  • Work with Rx data in Excel and/or TrueScripts dashboard
  • Reach out to members to assist in a change of Rx to a more cost-effective generic alternative
  • Provide members with co-pay assistance for brand and specialty medications
  • Act as patient advocates when excluded medications are identified - communicate effectively with all parties involved
• Claims Logging, Invoicing & Reporting
  • Log Specialty Care, Brand Care, Paper Claims, and Fee for Prior Authorizations on SharePoint
  • Log Specialty and Non-Specialty Prior Authorization approvals on SharePoint
  • Prepare and send weekly/monthly invoices to the Accounting team
  • Document actions and outcomes in the client database
• Administrative Support
  • Identify process/procedure improvements and update documents on SharePoint
  • Schedule meetings/conference calls as requested
  • Assist with creating/updating marketing materials in Publisher/Word
  • Assist Data Analytics team with report preparation for client annual reviews in Excel
• Performs other duties as assigned

Requirements
What you're made of
The bold requirements
Education: Associate degree - related field preferred, but not required
Licenses and Certification: Active pharmacy technician or LPN license preferred, but not required
That something extra we'd love to see

• Two years of applicable experience preferred
• Experienced pharmacy tech, case management, or customer service experience preferred but not required
• Knowledge of claims processing helpful
• Analytical thinking and attention to detail
• Problem-solving skills
• Excellent communication and customer relations skills
• Ability to multi-task and prioritize in an ever-changing environment
• Strong computer skills including Microsoft Office (Excel, Word, PowerPoint, Outlook)