Clinical Care Representative

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…

If you are an “A Player” looking for a new challenge, a fulfilling career, and a family-based values company, we welcome the opportunity to meet with you. TrueScripts is a Prescription Benefits Management (PBM) company. We manage prescription plans for self-insured businesses.

A potential candidate’s values must match our TrueScripts business core values of Integrity, Respect, Innovation, and Service an inherent trait to always provide a high level of Service. This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a ‘can do, proactive attitude – staying out in front of the curve so that we can best advise our clients of the ever-changing world in prescription management.

Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed.

Our team members enjoy:

• Robust benefits and a strong salary
• ESOP - Team Member Owned
• Employee Assistance Program
• Wellness Program
• Dream Manager Program (yes, it’s a real thing!)
• A cohesive, family-based culture
• Charitable contributions
• Paid Volunteer Time
• Lots of celebrations!

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

Requirements:

Education: Associate degree - related field preferred, but not required

Licenses and Certification: Active pharmacy technician preferred, but not required

That something extra we´d love to see

• Two years of applicable experience preferred
• Experienced pharmacy tech 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)