Our client is a global medical device and pharmaceutical manufacturer, as well as the leading provider of dialysis services and products in the United States. They are looking for an individual with experience in handling pharmacy insurance claims to join the team in their Franklin, TN location. This position is a pilot role for the department. It is currently only a 3-6 month contract, but depending on performance and business needs, has the potential to be a longer-term role. Candidates must have medical and/or pharmacy insurance claims experience, ideally in a community pharmacy setting. Once trained, the hours will be 9:30am -6:00pm.
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 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.
- Initiates prior authorizations
- Reaches out to clinic staff regarding prior authorization information
- 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.
- High School Diploma or equivalent required
- Prior courses in insurance billing and data processing preferred
- Pharmacy Technician Certification preferred
EXPERIENCE AND REQUIRED SKILLS:
- 1 - 2 years’ pharmacy claims 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.
Job Types: Full-time, Temporary
Salary: $16.50 /hour
- pharmacy insurance claims handling: 1 year (Required)
- High school or equivalent (Required)
- Pharmacy Technician (Preferred)
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