Fresenius Medical Care North America • Franklin, TN 37065
Job #2692903796
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.
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.
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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