Clinical Information Systems Director jobs in Detroit, MI

SUMMARY:

Performs a variety of functions related to pharmacy benefit management support including but not limited to provider support and client and member prescription claim processing services.  Functions as a first line resource in providing customer support for prescription benefit services primarily through phone, fax, and email.

PRINCIPLE RESPONSIBILITIES includes but are not limited to:

• Answers incoming telephone calls related to pharmacy provider support or member benefit coverage determinations using established protocols and plan rules.
• Reviews daily claim rejections and reference codes to determine if follow-up with Pharmacy/Member is required and will follow up with pharmacy/member as needed for claim resolution.
• Enrolls new members and/or processes terminations as needed.
• Maintains pharmacy call log summary.
• Performs transaction overrides as required and approved by client groups.  Maintains complete documentation of formulary overrides in proper notes section of member profiles.
• Develops automated reference materials (intranet access) of updated plan information.
• Serves as Training Facilitator for new recruits in the pharmacy call center.
• Voluntary participation in on-call rotation covering one weekday evening and a weekend shift on an alternate rotation basis.
• Assists with the implementation, QA, plan review, and claims unit testing of new plans and any client group wide change as needed.
• Performs various related duties as assigned including but not limited to Pharmacy Network updates; Pharmacy direct member reimbursements; ID card management and distribution; etc.

SKILLS AND REQUIREMENTS:

• Education:
• High school diploma or equivalent required, post high school education preferred.
• Specialized training as a Certified Pharmacy Technician or equivalent required.
• Experience:
• Minimum two years experience in a customer service position, preferably in a call center environment. 
•  Work experience as a pharmacy technician or a similar service position in the health care industry is a strong plus.
• Must have strong customer service orientation and excellent communication skills, and the ability to work effectively with clients, pharmacies and plan members.    
• Proficient PC skills in Windows-based applications.
• Health insurance background and knowledge of pharmacy terminology desired.
• Ability to be flexible and quickly adapt to the changing needs in the department.
• Must be highly organized with strong attention to detail.
• Must be flexible with scheduled work hours.
• Must be willing to provide pharmacy on-call support and coverage on a rotational basis.

PHYSICAL DEMANDS

Requires sitting, standing and occasional light lifting.

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at (678) 248-4755 or email us at HR@procarerx.com. 

ProCare Rx is an Equal Opportunity Employer.