Insurance Specialist

2 weeks ago

Franklin, United States FRESENIUS MEDICAL CENTER Full time

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:

  • Verifiesinsurancecoverage by phone,onlineorthroughE1(electronicsystem)transactionsfornewpatientsand/orchangesincoverage.

  • Maintainsconfidentialityofinformationatalltimes.

  • Assistspatientswithunderstandingtheirpharmacybenefitsandavailableresources.

  • Educatespatientsregardingavailabilityofalternativeinsuranceoptions,suchasprovidingMedicarepart D assistanceandeducation.

  • AssistswheninsurancecoveragechangesbetweencompaniesortoMedicare,and/orreferspatientsto a socialworker.

  • Answerspatients’questionsregardinginsurancecoverage.

  • Provides contact center customer service support related to insurance inquiries.

  • Refersescalatedquestions/situationstosupervisororappropriatedepartment(suchasBillingtoaddress a Billingerror),orif a patientwantstooptoutoftheprogram.

  • Inputs and updates insurance information related to pharmacy benefits (i.e Medicare Part D, Commercial Plans and State Medicaid, etc)

  • Ensures Pharmacy claim rejections are resolved to allow for timely shipping of medications.

  • Contacts payers to gather benefit coverage information and resolve third party rejections on claims.

  • Works a backlog of rejected claims for timely resubmission

  • Demonstratesknowledgeandunderstandingofinsurancebillingrequirements.

  • Works to meet the agreed upon service level agreements and or key performance indicators

  • Monitorsallpatients’ insuranceinformation to ensurethat it isupdated andaccurate.Addressesanyidentified anomaliesordiscrepancies,researchesandanswersquestionsasneeded.

  • Collaborates and communicates with Fresenius Kidney Care clinic partners.

  • Completesworkwithinauthorizedtimetoassurecompliancewithdepartmentalstandards.

  • ReviewsandcomplieswiththeCodeofBusinessConductandallapplicablecompanypoliciesandprocedures,local,stateand federallawsandregulations.

  • Assists with various projects as assigned bydirect supervisor.

  • Otherdutiesasassigned.

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 accommodationsmay be made to enable individuals with disabilities to perform theessential functions.

SUPERVISION:

  • None

EDUCATION:

  • HighSchoolDiplomarequired

  • Priorcoursesininsurancebillinganddataprocessingpreferred.

  • HealthInsuranceCertificationpreferred.

EXPERIENCE AND REQUIRED SKILLS:

  • 1 – 2 years’ customer service experience.

  • 1 – 2 years’ Health Insurance/ Payer Claims Experience is a plus.

  • Excellentcustomerservice,communication,organizationalandinterpersonalskillsrequired.

  • Demonstrates critical thinking and problem-solving skills.

  • Demonstrates analytical thinking skills.

  • Detailorientedwiththeability to enterinformationaccuratelyonpaperandinto a databasesystem.

  • ProficientwithPCsandMicrosoftOfficeapplications.

  • Develops a workingknowledgeofpharmacydispensingregulations,pharmacydatasystems,andpharmacybillingpracticesandpolicies.

  • Develops a workingknowledgeofstandardmedicalabbreviationsandmedicalterminology.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

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