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Eligibility Specialist
2 months ago
Job Title: CEG01D - Eligibility Specialist
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.
Supervisory Responsibility: N/A
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 preferred
- 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
Benefits:
At UBC, employee growth and well-being are always at the forefront. We offer an extensive range of benefits to ensure that you have everything you need to thrive personally and professionally. Here are some of the exciting perks UBC offers:
- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401k with company match*
- Tuition reimbursement
- Flexible work environment
- 20 days of PTO
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
UBC is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class. We are committed to a diverse, equitable and inclusive culture that fosters respect for each other, our clients, and our patients.
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