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 :

• Verifies insurance coverage by phone, online or through E1 (electronic system) transactions for new patients and / or changes in coverage.
• Maintains confidentiality of information at all times.
• Assists patients with understanding their pharmacy benefits and available resources. Educates patients regarding availability of alternative insurance options, such as providing Medicare part D assistance and education.
• Assists when insurance coverage changes between companies or to Medicare, and / or refers patients to a social worker.
• Answers patients’ questions regarding insurance coverage. Provides contact center customer service support related to insurance inquiries.
• Refers escalated questions / situations to supervisor or appropriate department (such as Billing to address a Billing error), or if a patient wants to opt out of the program.
• 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
• Demonstrates knowledge and understanding of insurance billing requirements.
• Works to meet the agreed upon service level agreements and or key performance indicators
• Monitors all patients’ insurance information to ensure that it is updated and accurate. Addresses any identified anomalies or discrepancies, researches and answers questions as needed.
• Collaborates and communicates with Fresenius Kidney Care clinic partners.
• Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• Assists with various projects as assigned by direct supervisor.
• Other duties as assigned. 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 accommodations may be made to enable individuals with disabilities to perform the essential functions. SUPERVISION :

• None EDUCATION :
• High School Diploma required
• Prior courses in insurance billing and data processing preferred.
• Health Insurance Certification preferred. EXPERIENCE AND REQUIRED SKILLS :
• 1 2 years’ customer service experience.
• 1 2 years’ Health Insurance / Payer Claims Experience is a plus.
• Excellent customer service, communication, organizational and interpersonal skills required.
• Demonstrates critical thinking and problem-solving skills.
• Demonstrates analytical thinking skills.
• Detail oriented with the ability to enter information accurately on paper and into a database system.
• Proficient with PCs and Microsoft Office applications.
• Develops a working knowledge of pharmacy dispensing regulations, pharmacy data systems, and pharmacy billing practices and policies.
• Develops a working knowledge of standard medical abbreviations and medical terminology. 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.

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.

Last updated : 2024-05-09