Patients First. Powered by Evidence.
Eligibility Specialist
Location
United States
Posted
1 day ago
Salary
0
Seniority
Senior
Job Description
Eligibility Specialist
UBC
• Provide the highest quality of customer service to patients and client representatives, which entail acquiring in-depth knowledge of client and marketing requirements • Complete verification of Benefits and Eligibility for all referrals from patients, medical doctor’s office (MDOs), health plans and pharmaceutical manufacturers • Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting on therapy • Review incoming referrals for completeness of and confirm FDA requirements are met as applicable • Answer all Incoming calls quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team • Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representatives • May provide billing and coding information related to specific product(s) • Conduct general payer research • Participate in call center activities, triage, and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies • Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns • Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited • Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures • Other duties as assigned
Job Requirements
- High School diploma or equivalent
- 3-5 years’ experience in a customer service setting preferably in a call center environment
- Previous experience in the PBM and or Healthcare Industry preferred
- Computer proficiency in MS Office applications, with database experience preferred
- Health insurance claims or patient accounting experience preferred
- Knowledge of third-party billing, coding, medical terminology, prior authorizations and appeals preferred
- Detail oriented with good analytical skills
- Ability to manage multiple priorities and meet deadlines
- Excellent written and verbal communication skills, demonstrated ability to communicate with others at all levels
- Excellent customer skills-patience to explain details and processes repeatedly, excellent phone presentation skills
- Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
- Advance problem-solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
- Ability to work a flexible schedule
Benefits
- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match*
- Tuition reimbursement
- Flexible work environment
- 20 days PTO, accrued
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine(Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
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