Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications.
Maintains high quality customer service standards in compliance with federal and state regulations and guidelines.
Responsibilities: Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefitsCommunicates case details to appropriate internal or external parties once benefit verification is completeIdentify any payer coverage restrictions and potential mechanisms for quickly accessing therapyAbility to effectively contribute alone or in small work groupsEffectively meets production and time completion goals Accurately document payer Prior Authorization and Appeals protocolsParticipate in special projects and perform additional duties as requiredMaintain repository of payer or brand specific coverage informationParticipate in training and process improvement initiatives Skills: Minimum of 2 years experience in customer service, insurance, benefits, marketing, sales, or related area, required, or Bachelors degree and 1 year of relevant experience Health care environment with third party benefits verification experience preferred.Understanding of commercial insurance concepts including coverage policies, major medical benefits, knowledge of government and patient assistance program, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third party terms and medical terminology is preferredAbility to write routine reports and correspondence using computer applications.
Excellent verbal skills and knowledge of medical terms.
Ability to work efficiently in Microsoft Office, including the creation of spreadsheets in Excel and the ability to take notes via computer keyboard during telephone conversations.
Skill in managing email correspondence and personal documentation of research.
Focus on fundamental analytic and problem-solving skills.Excellent time management skillsStrong professional customer services experienceHigh level of attention to detailBe a critical thinker who is adaptable, and results driven. Education: High school diploma or equivalent, required.
Bachelors degree preferred The hourlyrange for roles of this nature are $18 to $25/hr.
Rates are heavily dependent on skills, experience, location and industry.