ExactCare

Onboarding Specialist

• Call on prospective patients daily and schedule them for in-home assessments with our Clinical Liaison field representatives.
• Handle inbound calls from both patients and referral sources.
• Accountable for daily and weekly goals for assessments scheduled.
• Communicate effectively with patients.
• Work independently and also as a key member of the entire team.
• Maintaining constant contact with referral sources, field personnel and internal associates.
• Place scheduled assessments on the field representative calendar.
• Document all calls, tasks and appointments in Salesforce.
• Create positive first impression of ExactCare and the unique services we provide.
• Monitor and track daily assessments, assemble marketing materials, and conduct quality assurance calls.
• Participate in daily team huddles, attend training sessions and other ad-hoc meetings as needed.
• Other duties as assigned.

Onboarding Coordinator

Operations

• High level of contribution in front line, day to day work as assigned by leads and supervisors
• Provide training on department tasks to new hires, cross-trainees and existing team members requiring additional support
• Help coordinate the completion of cross-training through communication and scheduling with designated trainees
• Provide a high level of subject matter expertise to the department in supporting continuous improvement projects
• Support leads and supervisors in diagnosing and improving the performance of team members

Operations Trainer – Retention

Customer Retention Specialist

• Answering inbound calls from ExactCare’s existing patient base.
• Assisting with general inquiries, making payments, and questions regarding claims.
• Handling patient concerns and escalating issues as needed, ensuring all efforts are made to retain existing patients.
• Maintaining a consistently positive attitude and patient first approach to deliver stellar service to all patients.
• Maintaining current knowledge of products and services offered.
• Other duties as assigned.

Retention Specialist

Vice President

• Drives operational strategies to enhance clinical effectiveness and Stars performance to increase pay for performance revenue for ExactCare Pharmacy
• Drives Stars revenue for payers and associated value for ExactCare Pharmacy
• Collaborates to establish and manage payer performance expectations including Stars, outcomes, and value-based programs (e.g., quality bonus programs)
• Supports network pharmacy contract negotiations with subject matter clinical effectiveness and quality expertise and demonstrated ExactCare Pharmacy performance
• Develop and lead clinical effectiveness and Stars quality improvement strategy to support payer value proposition for ExactCare Pharmacy
• Serves as expert in understanding Medicare and CMS quality drivers for payer revenue
• Design clinical programs aimed at optimizing quality performance and evidence-based care
• Provide leadership and direction on clinical effectiveness and quality strategy
• Identify, prioritize, and execute on quality initiatives
• Interpret quality performance, identify trend, and design improvement strategies
• Monitor marketplace trends, literature, professional organizations, and regulatory bodies for new or revised best practices and standards related to clinical effectiveness and pharmacy patient care
• Interpret clinical effectiveness and Stars performance metrics, help identify trend, and design improvement strategies
• Continually improve and support implementation of clinical effectiveness, quality, and patient safety measurement strategy
• Support and facilitate implementation of innovation and systems that improve clinical effectiveness, and Stars experience to drive overall improved pharmacy quality and payer value proposition
• Support relationship managers with value proposition to solve patient experience barriers with health plans and PBMs including co-pay differential and medication synchronization fulfillment timing and overrides
• Build relationships and advocacy with key external clinical partners within Health Plans and PBMs to stimulate, surface, and shape demand for ExactCare Pharmacy services
• Ensure strong clinical effectiveness and quality service levels are achieved to support relationship managers with strong value messages during payer meetings and QBRs.
• Stay on top of clinical, quality and Medicare trends and information with health plans and PBMs that can impact the business, keeping leadership and key stakeholders informed of changes (e.g., policy, reimbursements)

VP, Clinical Effectiveness and STARS Quality

• Conduct a health and medication review with the patient that includes a thorough review of their list of medications and administration instructions and collecting key health information.
• Responsible for accurate data entry of a patient’s prescription information to ensure the patient will receive the appropriate medications
• Responsible for achieving key performance metrics as set forth by the management team
• Educate facilities, institutions and patients about ExactCare
• Manage the patient assessment process to grow business and maintain referral relationships
• Maintain accurate records and prepare reports for the consistency of information to be shared with the ExactCare team
• Partner and support with our Clinical Services team in the completion of MTM services.
• Call on prospective patients daily and schedule them for telephonic reviews and conduct patient follow up calls.
• Open lines of communication with management team
• Other duties as assigned

Account Manager

• Act as a first-line contact to clients and assist in answering questions and/or triaging concerns to increase client satisfaction and retention.
• Assist with implementation and on-site support for clients within region, as directed (pre- and post- implementation) to assist with smooth client onboarding and ongoing support.
• Develop, support, and strengthen client relationships; Address concerns and establish strategies for improving operations in various areas.
• Coordinate with internal teams to find and/or suggest solutions for client concerns or requests, or to improve service offerings.
• Present clients’ service-line related data Training Conduct monthly orientation calls, demonstrations of new products, or educational opportunities where necessary.
• Coordinate virtual and on-site educational sessions for clinical staff members on Operations.
• Perform EireneRx™ remote training for PACE Staff when needed.
• Illustrate market leading features and benefits of PACE Pharmacy Services.
• Support surveys and clinical research team (client satisfaction, market research surveys) and respond to data/feedback for specified regions as needed.
• Maintain and document client updates in CRM systems (i.e. approvals, contract requirements, customized requests, visits, education, training, phone calls, e-mails, etc.)
• Maintain current records of Agency Agreements.
• Implementation of new initiatives (e.g., system updates, EPCS, New Reports, Report Portal, Technology).
• 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.
• Ensure regulatory compliance between TRHC, clients and agencies; and track updates/changes for incorporation into policies and procedures.
• Ensures that HIPAA guidelines are followed in every communication with clients.
• Stay current on PACE/MTM/plan and benefit structures/Medicare Part D guidelines, as applicable.

Associate Account Manager

Data Entry

• Providing an exceptional customer service experience each day in a phone based environment.
• Enter a high volume of data; processing prescription information with speed and accuracy.
• Utilizing sound drug knowledge to effectively receive prescription authorizations, clarifications or transfers.
• Perform claim adjudication and auditing duties such as prior authorizations, billing and eligibility checks.
• Requiring outbound calls to patients.
• Working through current case queues to problem solve for patient care issues.
• Serving as a liaison between the clinical pharmacists and other medical professionals on patient’s behalf.
• Partner with technicians and pharmacists to ensure that new patients are successfully on-boarded to ExactCare.
• Maintaining patient records with strong attention to detail and confidentiality.
• Accurate retrieval of all prescription information and verifying through doctor calls.
• Placing welcome calls to newly on-boarded patients and establish a trusted point of contact.
• Placing outbound calls to patients to create, maintain or update their medication profiles.
• Serve as backup support for times of higher patient call volume.
• Effectively assist with patient questions over the phone.
• Performing in a high volume, fast paced environment to support ExactCare’s nationwide patient base.
• Other tasks as required.

Data Entry Technician

IT Support

• Answer telephone inquiries in a pleasant, professional and efficient manner assuring exceptional customer service
• Document all incoming calls and dialogue in the claims adjudication software
• Educate clients on plan policies, benefits and procedures
• Resolve client drug benefit concerns of a medical, financial, or technological nature
• Initiate and facilitate prior authorization requests
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines
• Participate in on-call rotation
• Accept other duties as assigned; including but not limited to: direct member reimbursement, processing, manual claims, reporting and researching rejected claims
• Attend department and company meetings and educational programs upon request
• Ensures that HIPAA guidelines are followed in every communication with clients