Benefit Verification Coordinator

3 weeks ago

Louisville, United States Knipper HEALTH Full time
Overview

YOUR PASSION, ACTIONS & FOCUS is our Strength

Become one of our Contributors

Join the KnipperHEALTH Team

KnipperHealth is a highly profitable, rapidly growing company that is competitively unique and nimble in service solutions. We offer incredibly competitive pay and benefits that start on your first day of employment.

  • Things you can expect within your first 90 days:
  • Zero time waiting for benefits
  • Welcoming team with a great culture
  • Classroom and on-the-job training
  • 30/60/90 check-ins with leadership team
  • Educational Assistance Opportunities
  • Toll allowance for hourly positions 
  • Interested in starting  a career in pharmacy with Knipper Health? Ask us about our company-sponsored Pharmacy Technician programs to become licensed in your state.

POSITION SUMMARY:

The Benefit Verification Coordinator is responsible for the coordination and processing of patient medication orders, to include order intake within regulatory boundaries, customer service coordination, and pharmacy technician duties as defined by policy and regulation and while under the supervision of a pharmacist.

Responsibilities

RESPONSIBILITIES:

  • Provide high quality customer service to patients and prescribers while protecting patient confidentiality.
  • Verify information on prescriptions received prior to processing (correct prescriber, name of patient, patient information, medication, dose, quantity, number of refills).
  • Effectively use our internal pharmacy management software, PrimeRx, to complete claims processing and prior authorizations.
  • Perform patient level benefits verifications as applicable for all pharmacy benefits plans.
  • Complete prior authorization templates per payer requirements to ensure medication orders will be covered by insurance plans.
  • Evaluate all completed prior authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations.
  • Processing of prior authorization responses via CoverMyMeds and submitting appeals if requested by patient/prescriber.
  • Communicate as necessary with patients to determine general health status, medication compliance, medication and supply inventory, and overall coordination of care and service (custom assessment in software system) as applicable.
  • Make outbound calls to prescribers, patients, and insurance companies.
  • Assist with inbound calls as needed for respective program(s).
  • Perform follow up on all outstanding prior authorizations/orders while following program specific correspondence for patient/prescriber/insurance.
  • Adhere to program specific rules and timelines when processing orders.
  • Prepare and maintain patient profile, medication administration records, and other documents as needed when setting up orders for shipment.
  • Perform all other duties as assigned.

The above duties are meant to be representative of the position and not all-inclusive.

Qualifications

MINIMUM JOB REQUIREMENTS:

  • High School diploma or equivalent
  • Two (2) years of experience providing customer service to internal and external customers, including meeting quality standards for services
  • Registered and licensed pharmacy technician by the Kentucky and/or Indiana Board of Pharmacy in good standing or ability to obtain license during onboarding.
  • Advance knowledge of medical terminology (including sig codes and Roman numerals), brand and generic names of medications, and general pharmacy terminology
  • Ability to read, write, speak, and understand the English language

PREFERRED EDUCATION AND EXPERIENCE:

  • 6 months customer service experience, payer benefits experience with reimbursement and prior authorizations, healthcare industry experience, license, or equivalent coursework.
  • Nationally certified through the PTCB or another approved certifying agency
  • Experience with HIPAA and patient services
  • Knowledge of insurance procedures

KNOWLEDGE, SKILLS & ABILITIES:

  • Excellent organization skills and detail oriented
  • Demonstrated empathy and compassion
  • Excellent verbal and written communication skills
  • Balance multiple priorities to meet expected response deadlines
  • Adaptable, flexible, and readily adjust to changing situations
  • Ability to work independently and as a member of a team
  • Ability to comprehend and apply basic math principles
  • Ability to apply logical thinking when evaluating practical problems
  • Ability to present information and respond to questions from stakeholders
  • Ability to interact with a diverse group
  • Ability to listen and demonstrate a high degree of empathy
  • Demonstrated computer skills includes Microsoft Word, Excel, and Outlook
  • Display tact and diplomacy in response to unfavorable or negative situations
  • Demonstrated sensitivity and understanding when speaking with patients
  • Demonstrated passion for speaking with people in an outgoing way

PHYSICAL DEMANDS:

  • Location of job activities 100% inside
  • Noise and / or vibrations exposure
  • While performing the duties of this job, the employee is regularly required to talk or hear
  • Stand and sit for prolonged periods of time
  • This job operates in a professional office environment that uses standard office equipment such as computers, phones, and printers

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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