Summary: Responsible for all activities in the Member Benefits area. Maintains accurate records, audits methods and procedures of member benefits functions to improve efficiency by performing the following duties.
Bachelor's degree (B. A. / B. S.) from four-year College or university; six to eight years related experience working in a pharmacy with insurance and/or medical billing.
Certificates and Licenses:
Duties and Responsibilities include the following. Other duties may be assigned.
Supervises and provides necessary training to Members Benefits Management employees.*
Holds regular staff meetings as necessary to disseminate new information.*
Reviews current policies and procedures with staff when necessary.*
Corrects and approves the time clock punches.*
Assists and/or performs monthly, 90-day, and yearly evaluations within the Members Benefits Management Department.*
Contacts insurance companies, patients, and doctor's offices in attempt to complete prior authorizations, benefit investigations and appeals.*
Speaks with patients to compile information for insurance companies.*
Shows compassion, patience, and understanding when speaking with patients.*
Follows-up to determine patients' process status.*
Fills-in on other departmental duties as needed, calling for prescription refills, dispensing, data entry, and filing.*
Maintains patient confidentiality.*
Performs other duties and responsibilities as assigned
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Internal requirements: 1 year in current supervisor position at Diplomat; 6 months of consistently meeting metrics in supervisor role – must be documented. No write ups in previous 6 months.
Directly supervises supervisor employees in the Members Benefit Management Department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
To perform this job successfully, an individual should have knowledge of Microsoft products.
Knowledge, Skills and Other Abilities:
- Knowledge of store operations
- Knowledge of contracted rates from insurance plans including insurance coding
- Understand Medicare Parts B and D
- Ability to develop lasting relationships with third party payers
- Experience in supervising others with effective delegation
- Excellent oral and written communication skills with a positive work attitude and willingness to learn and grow in the position
- Organizational skills
- Customer service skills
- Ability to multi-task
- Ability to work as a team
- Independent and self-motivated
- Ability to work and accomplish goals with little to no supervision
- Dependable and able to act with discretion maintaining levels of strict confidentiality
- Time management
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to walk; sit and use hands. The employee is occasionally required to stand.
Diplomat Specialty Pharmacy - 18 months ago