Prescription Monitoring Program Specialist

Job Summary

As a Prescription Monitoring Program Specialist, this role will perform administrative tasks and duties generated by the clinical and non-clinical team members working within the Prescription Monitoring Program (PMP) program. As a team member, you will regularly collaborate and engage with other team members to support day to day operational tasks and duties assigned, including triaging inbound calls, conducting outbound calls and managing faxed documentation. Along with ensuring accuracy and efficiency, this role requires significant attention to detail, ability to prioritize and organize your work and regularly assess current workflows and create efficiencies. Duties may be performed in a virtual work environment.

Education & Experience

Required:

• High School Diploma or G.E.D.
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Minimum 2 years’ in administrative or medical office environment
• Proficient with Microsoft Office suite, especially Excel
• Proficient knowledge of medical terminology

Preferred:

• Experience in a customer service healthcare environment and/or Managed Care experience
• Medical Assistant diploma or certificate of completion
• Associate degree in healthcare, pharmacy, or a related field
• Prior experience in a Managed Care Organization (MCO)
• Prior experience with TRICARE

Key Responsibilities

• Proactively evaluate and process assigned tasks within the medical management system.
• Respond to daily phone requests and messages in an efficient and professional manner.
• Provides outreach for and receipt of medical records in support of PMP processes and workflows.
• Fax educational materials and records requests to provider offices.
• Track documentation and follow up on outstanding responses.
• Research provider details such as fax numbers, affiliations, and practice locations.
• Maintain and update internal provider database with accurate contact info and review statuses.
• Organize digital files and support case preparation for clinical reviewers.
• Communicate clearly and professionally via fax, email, and phone.
• Processes authorization requests in the medical management system.
• Works with standard coding systems including: Standard Medical Taxonomy, International Classification for Diseases, Current procedural Terminology and Health Care Financing Administration Common Procedure Coding System. • Create cross-functional communication channels with other medical management teams and departments within the organization.
• Communicates with medical providers, and beneficiaries to clarify documentation prior to processing.
• Consistently displays professional and courteous service skills to internal and external customers.
• Utilizes various computer software applications.
• Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries personable identifiable information (PII) or protected health information PHI.
• Compile and create presentation materials utilizing Microsoft PPT, Adobe and other tools.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TEAMs, TriWest Intranet, the Internet, and department software applications.

Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Working knowledge of the healthcare system, medical practices and standards of care. Knowledge of TRICARE programs and benefits, managed care programs or other government healthcare programs.

Working Conditions

Working Conditions:

• Availability to work any shift
• Ability to work overtime, if needed
• Remote: Private and secure workspace and workstation with high-speed internet is required
• Ability to work independently from home
• Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone
• Department of Defense security clearance required