Job Details

Overview

Scope of Responsibilities: Assist with the day-to-day operations of the clinical department of ProAct. Works under direct supervision and follows standard procedures to accomplish assigned tasks.

Job Summary: Responsibility for assisting with the prior authorization process and with tasks to meet the clinical needs of ProAct clients and members. Works closely with Clinical Services Specialist to prioritize tasks and responsibilities.

Responsibilities

Job Duties:

• Assist in preparation, organization, and communication regarding prior authorization requests.
• Provide Help Desk support, where appropriate, for questions regarding overrides or clinical system edits.
• Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate.
• Assist in preparation of member mailings for various cost containment/clinical programs.
• Assist in finding most cost-effective channels for specialty medications and being sure medications are being filled through proper network channels.
• Assist in the preparation, where appropriate, of reports or records of prior authorization activity including invoicing documents for client billing.
• Assist in the development and updating of formulary documents or other clinical-specific documents.
• Assist with the day-to-day operations of the ProAct Help Desk when needed.
• Responsible for completing all mandatory and regulatory training programs
• Perform other duties as assigned

Qualifications

Attendance Requirements:

• Must be available, and on-time for scheduled work shifts

Educational Requirements:

• Minimum: High School Diploma (or currently enrolled) or GED
• Preferred: AS Degree or Higher

Experience:

• Preferred: mimimum 1 year experience as Rx Technician or Customer Service Representative in a health care related service.

Special Conditions of Employment:

• Drug test
• Initial and continuous exclusion and sanction/disciplinary monitoring
• Any and all additional eligibility requirements based on the specific position

Job Skills Required:

• Strong Communication Skills, must be able to effectively communicate both on the phone and in group setting
• Strong Organizational Skills
• Proficient in using Microsoft Excel, Word and Access
• Must be able to work independently

Behavioral Traits:

• Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and other in contact with
• Initiative: Must work within supervision guidelines and assume additional responsibilities
• Flexibility: Must be willing to work variable work schedules, assist others as requested and available, and be willing to perform all assigned work
• Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences
• Involvement: Must enjoy the demands of the job and work with interest and enthusiasm
• Customer Service: Must provide appropriate customer service (for Kinney customers, fellow employees and business partners), listen attentively to their needs and respond appropriately
• Safety: Must take care of equipment and employ good safety habits
• Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams

Compensation

$17.84-18.19 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience, and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state, and federal regulations as it pertains to minimum wage requirements.