Pinnacle Claims Management, Inc. (PCMI) seeks a Patient Care Coordinator to enhance our Pharmacy Benefits Management (PBM) customer service. Reporting to the PBM Supervisor, you will serve as a subject matter expert, working directly with members and vendors to resolve issues and improve the overall member experience.
What You'll Do
- Respond to member questions via phone, email, and written correspondence regarding prescription drug benefits, including Prior Authorization status, eligibility, and pharmacy claim overrides.
- Assist Benefits Coordinators with coordinating the intake and processing of Prior Authorization Requests between doctors, patients, and pharmacies.
- Support Benefits Coordinator II with training CSRs to handle customer service inquiries.
- Help the Benefits Coordinator II develop customer service policies and procedures for agents.
- Assist Benefits Coordinators and the Supervisor in resolving escalations to meet Service Level Agreements.
- Manage the PBM customer service Help Desk for day-to-day tasks, including Prior Authorization tickets, after-hours messages, and direct member reimbursements.
- Support the development of client-facing reporting and communications.
- Implement elevated, 'white glove' customer service standards for PBM.
- Achieve service level targets across email, ticket management, and pharmacy operations.
- Utilize creative methods to understand customer perceptions of their interactions with our services.
- Contribute suggestions and workflow improvements.
- Help maintain and improve the reporting environment by delivering operational reports, dashboards, and forecasts.
- Back up and assist Benefits Coordinators in process improvements, analytics, project management, and quality assurance.
- Maintain internet speed of 40 MB download and 10 MB upload and a router with wired Ethernet.
- Maintain a HIPAA-compliant workstation and use appropriate security techniques to protect confidential data.
- Maintain and service safety equipment such as smoke detectors, fire extinguishers, and first aid kits.
What We're Looking For
- High school diploma.
- 1 to 3 years of experience in Pharmacy Benefit Management or retail pharmacy practice.
- Patient Care orientation with the ability to set priorities and meet turn-around time frames.
- Excellent written, oral, and interpersonal communication skills.
- Strong skills for project-based tasks.
- Ability to work effectively in a fast-paced environment.
- Analytical thinking and problem-solving capabilities.
- Clear and concise telephone voice and communication skills.
- Ability to adapt to a constantly changing environment.
- Proficient organizational and time management skills.
- Fluent in English (oral and written).
- Ability to maintain a HIPAA-compliant workstation.
- Internet access via cable or fiber with 40 MB download and 10 MB upload speeds.
- Home router with wired Ethernet (no wireless connections or hotspots).
- A designated, secure home office space.
- A functioning smoke detector, fire extinguisher, and first aid kit on site.
Nice to Have
- Valid Pharmacy Technician Certification Board Certification (PTCB).
- Bilingual in Spanish.
Team & Environment
You will report to the Supervisor, Pharmacy Benefits Management (PBM). You'll work collaboratively with Benefits Coordinator I & II, the Supervisor, and a team of highly skilled experts.
Benefits & Compensation
- Salary range: $39,208 - $55,972.
- Rich benefits package that includes profit-sharing.
Work Mode
This is a fully remote position.
Pinnacle Claims Management, Inc. is an equal opportunity employer.
