Client Relationship Specialist

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🕒 5 days ago

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ExactCare

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2009

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

Healthcare • Healthcare Insurance • Pharmaceuticals

ExactCare is a leading pharmacy care management provider that specializes in medication management for individuals with complex, chronic medical needs. With operations in all 50 states and Washington, D. C. , ExactCare supports more than 100,000 people nationwide, helping them manage their medications in assisted living, long-term care facilities, and at home. Partnering with healthcare organizations, ExactCare aims to improve clinical outcomes by ensuring better medication adherence, reducing readmissions, and lowering overall healthcare costs.

📋 Description

• Serve as the main contact for external clients requesting Medicare D and Commercial products • Handle formulary compliance, plan set-up, provider management, member enrollment and eligibility changes, patient concerns, reporting, audit support, and claims assistance • Perform client outreach and establish recurring calls • Submit internal workload requests to the Manager • Prepare, submit, and analyze PDE submissions to CMS • Research solutions for submission rejects and assist with PDE data reconciliation • Summarize and report PDE progress • Support clients with Part D functions and regulatory compliance • Coordinate regulatory reporting submissions and meet critical deadlines • Track regulatory updates and incorporate changes into policies and procedures • Answer client questions and triage concerns to other associates • Build relationships with clients and pharmacies • Present company product-line services to clients • Follow HIPAA guidelines in all client communications • Maintain current knowledge of plan and benefit structures, pharmacology updates, and Medicare Part D guidelines • Attend department and company meetings and educational programs • Assist with Help Desk calls • Perform administrative duties and other assigned projects

🎯 Requirements

• Associate’s degree or formal training beyond high school required • Bachelor’s degree preferred • 3+ years of customer service and industry experience • Health plan or insurance experience is a plus • PBM experience preferred • CPhT certification is a plus • Experience in a pharmacy support role is a plus • Current knowledge of plan and benefit structures and Medicare Part D guidelines • Proficiency resolving common issues, questions, and solutions • Knowledge of pharmacology and pharmacological terms • Excellent communication skills and professionalism when working with clients • Ability to solve problems under pressure and make immediate decisions • Detail-oriented with ability to prioritize workload • Strong computer skills, including word processors, spreadsheets, and database software • Ability to work an average of 40 hours per week and be available outside normal business hours on an ad hoc basis • Must be eligible to work in the United States • Ability to meet the physical demands of hearing, seeing, sitting, standing, talking, and walking • Travel may be required for special organization or department events, team meetings, trade shows, conferences, and client engagements

🏖️ Benefits

• Medical, dental, and vision coverage • Flexible spending account • Company-paid life insurance • Short-term disability coverage • Voluntary benefits • 401(k) • Paid Time Off • Paid holidays • Remote position • Educational programs • Travel opportunities for special organization or department events, team meetings, trade shows, conferences, and client engagements