Job ID 19000B10
Available Openings 1
PURPOSE AND SCOPE:
Reviews, verifies, and processes orders in the pharmacy management system's work queue. Serves as a resource to patients, dialysis facility personnel, and other Fresenius Medical Care employees for insurance coverage and pharmacy benefit related issues.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Verifies insurance coverage by phone, online or through E1 (electronic system) transactions for all new patients and/or changes in coverage.
- Contacts all new patients (via telephone) to verify the amount(s) that will be paid out-of-pocket/co-pays.
- Maintains confidentiality of information at all times.
Assists patients with understanding their pharmacy benefits and available resources.
- Educates patients regarding availability of alternative insurance options, such as providing Medicare part D assistance and education.
- Assists when insurance coverage changes between companies or to Medicare, and/or refers patients to a social worker.
- Answers patients' questions regarding insurance coverage.
- Refers escalated questions/situations to supervisor or appropriate department (such as Billing to address a Billing error), or if a patient wants to opt out of the program.
- Enters patient insurance information under the patient's account in the pharmacy data system.
- Reviews all enrollment forms. Ensures insurance information and appropriate referrals have been completely and accurately obtained. May be required to follow up with social worker, insurance company, and/or patient to complete the application and verify insurance.
- Demonstrates knowledge and understanding of insurance billing requirements.
- Monitors all patients' insurance information to ensure that it is updated and accurate. Addresses any identified anomalies or discrepancies, researches and answers questions as needed.
- Analyzes patient reports from pharmacy data system as an audit check to ensure the correct insurance information is entered and that other changes are not overlooked. Researches and corrects any discrepancies identified.
- Prepares monthly reports to track work progress.
- Completes work within authorized time to assure compliance with departmental standards.
- Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
- Assist with various projects as assigned by direct supervisor.
- Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- High School Diploma required
- Prior courses in insurance billing and data processing preferred.
- Health Insurance Certification preferred.
EXPERIENCE AND REQUIRED SKILLS:
- 1 – 2 years' customer service experience.
- Excellent customer service, communication, organizational and interpersonal skills required.
- Understands the importance of, and demonstrates a customer service philosophy.
- Excellent written and verbal communication skills.
- Excellent organizational and analytical skills.
- Detail oriented with the ability to enter information accurately on paper and into a database system.
- Proficient with PCs and Microsoft Office applications.
- Develops a working knowledge of pharmacy dispensing regulations, pharmacy data systems, and pharmacy billing practices and policies.
- Develops a working knowledge of standard medical abbreviations and medical terminology.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
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