Baltimore, United States
11 months ago
Processes direct member reimbursement (DMR) requests received by mail, fax, electronic portal or telephone.
Works in various queues to ensure proper handling and proper time management of all processes related to DMR requests.
Responsible for meeting all quotas as outlined in departmental goals.
Actively listens to customers, probes for clarification, and provides DMR, coverage determination and/or appeals guidance based upon customers individual needs.
Responds to inquiries from customers for information and assistance related to the DMR request.
Contacts members, pharmacies, physicians and other facilities to gather necessary case info not limited too; co-payments, levels of care, alternate medications tried and failed, NPI and another required data.
Performs extensive research to respond to inquiries and process cases while interpreting policy provisions to determine most effective response. Assist co-workers in completion of critical tasks during times of peak case loads
Seeks assistance with complex customer services issues/ DMR inquiries.
Makes outbound notification calls to members and/or their appointed representatives regarding status of requests.
Must be able to sit for the majority of shift and be comfortable working in a call center environment.
All work is subject to review and follow up for errors and coaching by management staff.
Maintains all company and regulatory compliance guidelines.