Insurance Specialist

PURPOSE AND SCOPE:

Reviews,verifies,andprocessesordersinthepharmacymanagementsystem’sworkqueue.Servesas a resourcetopatients,dialysisfacilitypersonnel,andotherFreseniusMedicalCareemployeesforinsurancecoverageandpharmacybenefitrelatedissues.

PRINCIPALDUTIESAND 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.

• HighSchoolDiplomarequired
• Priorcoursesininsurancebillinganddataprocessingpreferred.
• HealthInsuranceCertificationpreferred.

EXPERIENCEAND 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.