Eligibility Specialist

United Biosource Corporation - Morgantown, WV3.3

Full-timeEstimated: $23,000 - $31,000 a year
EducationSkillsBenefits
If you are looking to gain a wide range of experience and contacts, UBC may be the place for you.

People are the driving force at UBC and are still our most valuable resource. The work we do at UBC is very rewarding and every day is a different challenge. We work on critically important therapeutic areas, including cancer; mental health; metabolic diseases; like Pulmonary Arterial Hypertension and neurological diseases, like Parkinson’s. Our days can be long and a fast-paced environment but we know there are thousands of people counting on us.

Brief Description:
Provide the highest quality of customer service to patients and client representatives, which entail acquiring in depth knowledge of client and marketing requirements. Complete verification of Benefits and Eligibility for all referrals from patients, medical doctor’s office (MDOs), health plans and pharmaceutical manufacturers. Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting on therapy.

Specific job duties:
Review incoming referrals for completeness of and confirm FDA requirements are met as applicable. These are typically received via facsimile, Web portal or client partner download.
Answer all Incoming calls quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team.
Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representatives
May provide billing and coding information related to specific product(s)
Conduct general payer research
Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy.
Participate in call center activities, triage, and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.
May serve as single point of contact for an assigned group of prescribers.
Effectively manage and work though action item list to ensure it is current and tasks are completed in a timely fashion.
Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns.
Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.
Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.
Other duties as assigned.

Desired Skills and Qualifications:
High School diploma or equivalent
3-5 years’ experience in a customer service setting preferably in a call center environment; Previous experience in the PBM and or Healthcare Industry preferred
Computer proficiency in MS Office applications, with database experience preffered
Health insurance claims or patient accounting experience preferred
Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred
Detail oriented with good analytical skills
Ability to manage multiple priorities and meet deadlines
Excellent written and verbal communication skills, demonstrated ability to communicate with others at all levels
Excellent customer skills-patience to explain details and processes repeatedly, excellent phone presentation skills
Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
Advance problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
Ability to work a flexible schedule

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