Benefit Verification Representative

Buffalo Grove, IL

Post Date: 06/19/2017 Job ID: 22386 Category: Professional

Job Description:
  • We help individuals by selecting a personalized, pharmacist-led team, who proactively review dosing and medicine schedules, troubleshoot injection-related issues, discuss side effect management, and reinforce doctor instructions to ensure the individual s prescribed medicine is administered appropriately.
  • Manage all benefits investigations on behalf of the Plan Participant determining their benefit coverage, communicating the financial obligations, and obtain all the necessary authorizations from the participant, the insurance company and doctor.
  • This research is managed through a series of phone calls and updating of system data with the responsibility to communicate routinely amongst related parties as to status updates.
  • The end goal is to bring resolution to a plan participant s case identifying if the participant will enroll in the therapy support and communicating this within our organization to initiate the dispensing process.

  • Conducting a detailed benefit and eligibility verification of insurance benefits for plan participants, including identifying the different plan and therapy requirements for processing their referrals, and validating the demographic and reimbursement information on all Specialty customers in a database prior to the initiation of therapy.
  • Processing POS/Retail billings, relating financial obligations to the participant, and informing internal parties when a new customer is brought on for service.
  • This role is predominately phone centric with essential skills in navigating our system to document conversations and outcomes as well as managing follow-up actions with opportunities for internal communications with the sales organization regarding contract and physician issues.
  • Responsible for understand and communicate medical information, identify potential issues, collect and document/publish data, establish facts, draw conclusions, and solve problems is essential.
  • The commitment is to communicate the referral status every 48 hours to the Physician and Participant with objective of closing 8 referral cases a day, post training.
  • This position must comply with the business principals, ethical standards, legal obligations and policy as outlined in the Compliance and Ethics program to protect patient information.

  • Benefit Verification experience.
  • Medical Receptionist experience.
  • Billing or Insurance Experience.
  • Call Center \ Computer experience.
  • Someone that is caring and works well with sick patients.

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