AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs-wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.Job DetailsThe Sr. Client Experience Specialist is responsible for acting as a first-line resource for external product lines regarding Third Party Administrator (TPA) operations. This individual will have expanded knowledge of products, industry practices, and trends. In addition, this individual will provide routine account management services to meet the needs of the client and advocate for client priorities. In this role, you will develop, support, and strengthen client relationships alongside the Account Management team and Client Experience Managers. This role is essential in addressing needs/concerns and assist in establishing solutions to improve operations in various areas by having routine contact with clients. Additionally, this position also assists with various internal tasks that ensure a high level of overall client satisfaction.
Responsibilities- Prepare and maintain active project plans for each client and present updates in regularly scheduled calls.
- Coordinate the submission of reporting for client and for appropriate management to ensure critical deadlines are met.
- Perform risk assessments/quality reporting, and monthly reporting, as directed.
- Problem solve and identify solutions in various areas, including but not limited to claims processing, claims payment, enrollment, and provider contracts.
- Participate in regularly scheduled calls (pre- and post-implementation), as needed to support staff.
- Coordinate with internal teams to find and/or suggest solutions for client concerns or requests, or to improve service offerings.
- Coordinate and conduct phone and email outreach.
- Coordinate the submission of regulatory reporting to appropriate management and/or governing agencies to ensure critical deadlines are met.
- Assist in the reconciliation of data/data entry, as needed, for reporting and submissions.
- Perform risk assessments/quality reporting, and monthly reporting, as directed.
- Maintain and document client updates in CRM systems (i.e. approvals, contract requirements, customized requests, visits, education, training, phone calls, e-mails, etc.)
- Ensure regulatory compliance between our company and clients; and track updates/changes for incorporation into policies and procedures.
- Stay current on PACE/MTM/plan and benefit structures/Medicare Part D guidelines, as applicable.
The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.
QualificationsThese represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Associate's degree or formal training beyond high school
- Bachelor's degree in related field is preferred
- Required:
- Five (5) to eight (8) years of professional work experience in a health plan setting in account management, client relations, customer service, or operations.
- Three (3) to five (5) years of professional experience in building client relationships and problem solving.
- Minimum of three (3) years of health insurance claims experience.
- Preferred:
- TPA (Third Party Administrator) experience.
- Knowledge of the complexities of Medicare, Medicaid, and PACE.
Skills & Abilities - Knowledge and experience using current computer technology, and a strong knowledge of Microsoft 365 Applications; ability to easily adapt to new systems.
- Excellent written and verbal communication skills, and professionalism when working with clients.
- Ability to read, comprehend and analyze provider contracts.
- Ability to summarize complex issues and communicate them in a way that is clearly understandable by clients.
- Ability to solve problems under pressure by making immediate decisions while on the phone/in-person.
- Detail oriented and able to prioritize workload.
- Strong computer skills and ability to navigate spreadsheets, reports, documents and database and proprietary software.
- Ability to manage multiple priorities and work independently.
- Skilled in problem resolution and root cause analysis
- Skilled in establishing and maintaining effective working relationships, with internal and external customers.
- Ability to demonstrate resourcefulness and resolve issues in a timely manner.
- Ability to work independently with minimal supervision.
- Ability to communicate professionally, clearly, and effectively, verbally and in writing.
- Ability to prioritize effectively.
Physical DemandsThis job operates in a professional, dressed for your day, remote environment. This role routinely uses standard office equipment such as computers, phones, printers, and filing cabinets. While performing the duties of this job, the employee is regularly required to talk or listen.
ScheduleSchedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.