Specialty Subject Matter Expert (SME)

Company Name:
As a member of the leadership team for the brand support division, the team lead will demonstrate and utilize professional conduct when interfacing with staff and clients. The SME position provides assistance to the supervisor in the areas of daily work distribution, quality monitoring and auditing, program and system documentation development and training, client interaction on processes, program performance and feedback on staff performance.
Awareness of program performance indicators
Serves as a primary contact for staff in regard to program process questions
Serves as a primary contact for staff in regard to system process and system utilization questions
Ability to motivate and lead team for positive service outcomes
Ability to identify and communicate problems in process and process flow
Support and coach staff's development for services rendered
Ensure timely and accurate departmental reports
Use performance measures to identify opportunities for staff and process improvement
Demonstrate commitment to client and client's needs
Ability to forecast workflow volumes
Ability to prioritize and distribute daily
Understanding of a business support service model
Oversees duties of Intake, Customer Service, Reimbursement Specialist, Case Managers I, II and III, and Healthcare Professionals (refer to job descriptions).
Other duties and responsibilities as assigned by Supervisor and Manager
Minimum (Required): _(must be met in order to perform the job at the required level)_
The team lead will have interaction with the supervisor and manager, as well as the client.
Team lead must demonstrate superior communication skills both written and verbal format.
Minimum Education Required:
A Bachelor's degree is preferred
Vocational or technical training is required
A designation as a Certified Case Manager or licensed practical nurse or social worker is also preferred
Three years experience in reimbursement case management, preferable in the insurance and/or pharmaceutical/biotechnology industry
Proficient in all aspects of reimbursement (i.e. benefit investigation, prior authorization, pre-certification)
Skilled in verbal and written communication
Preferred: _(if above and beyond the minimum required)_
Knowledge of Medical Terminology
Extensive knowledge of drug reimbursement issues and claim adjudication process
Knowledge of navigation through the claim denial process.
Knowledge of HCPCS, CPT and ICD-9 coding
Ability to express ideas clearly both written and oral communications
Ability to enter data correctly
Strong attention to detail and ability to handle multiple tasks well
Strong computer skills required; preferably Microsoft Word or Excel software applications
Data entry skills required
Ability to resolve problems independently
Ability to calculate figures and amounts such as discounts and percentages
Ability to carry out instructions furnished in written, oral or diagram form
Adaptable to changing priorities as needed
Have exceptional attention to detail and excellent analytical, investigation, and problem solving skills
Ability to manage multiple priorities concurrently
Responsible for meeting quality and turn-around-time objectives
Strong customer service skills; including ability to convey compassion for patients
Physical Demands: May sit (7) to ten (10) hours per day. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion. Visual acuity to see and read fine prints. Must be able to hear normal voice sounds. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role.
Work Environment: Work in a climate-controlled, smoke-free internal environment. These job responsibilities are executed as part of a customer service call center. The position will be located in a fast-paced organization with the potential for a variety of unplanned activities to occur simultaneously.
Equal Opportunity Employer: Omnicare is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, and veteran status or any other status protected by federal, state or local law. Omnicare is an Equal Employment Opportunity and Affirmative Action Employer.
Date: 2014-03-28
Country: US
State: KY
City: Louisville
Postal Code: 40223
Category: Case Manager
Job Type: Regular Full-Time

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.