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.
• Completes work within authorized time to assure compliance with departmental standards.
• 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.

• 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.