Benefit Verification Technician

Responsibilities

• Primary Key Performance Areas:
• KPA 1 - Insurance Verification
• Verify Private, Medicaid, and Medicare insurance coverages (include VA, IHS, and other unique programs).
• Complete patient facility (Hospital, Hospice, Rehab, ALF, Skilled Nursing, etc.) verifications and determine medication coverage.
• Verify patient eligibility to utilize AON Pharmacy via test claim to their pharmacy insurance.
• Refers prescriptions to our Prior Authorization or Financial Assistance teams based on test claim responses.
• Offer and enroll patients in manufacture copay cards for commercial payors to assist in covering patient financial responsibility.
• KPA 2 - Specialty Pharmacy Referrals
• Determine network coverage for specialty oncology and hematology medications.
• Determine which pharmacy can dispense on behalf of the patient.
• Inform patients of prescription referral to outside pharmacies and notify nursing staff to forward prescription.
• Document prescription referrals in the EMR system to alert physicians and clinic staff of the appropriate dispensing pharmacy.
• KPA 3 - Claims Resolution
• Obtain Limited Distribution Overrides for AON Pharmacy to fill.
• Understand claim responses regarding patient plan structure and educate patients regarding financial responsibility.
• Resolves COB coverage issues with patients and payor to correctly adjudicate claims.
• Resolve any claim submission issues with outside dispensing pharmacies that are outside the scope of the Intake team.
• KPA 4 - Pharmacy Call Center Communication
• Ensure effective communication and premier customer service with all internal and external customers.
• Demonstrate the ability to actively listen and understand patient questions and provide accurate answers and solutions. Will ensure that all phone calls are addressed professionally, courteously and in a timely manner.
• Act as a liaison between teams to communicate changes and help improve interdepartmental processes to improve patient care.
• Review incoming team emails to verify they are answered in a timely and professional manner.
• KPA 5 - Compliance
• Ensure all local, state, and federal guidelines are followed as well as corporate policies, pharmacy Standard Operating Procedures (SOPs) and accreditation bureaus' standards .
• Examples of job duties include, but not limited to:
• Verify all department compliance training is completed by the established deadlines.
• Maintain continuing education requirements for licensure.
• Performs other duties and projects as assigned
• Position Qualifications/Requirements:
• Education : High school education, GED, or equivalent required
• Certifications/Licenses : Active/Unrestrictive Pharmacy Technician permit in the state of residence. Willing to obtain Florida Technician permit (if applicable).
• Previous Experience : Two years' experience in specialty, retail, mail order, or hospital pharmacy as a pharmacy technician is required.
• Core Capabilities :
• Analysis & Critical Thinking: Critical thinking skills including solid problem solving, analysis, decision-making, planning, time management and organizational skills. Must be detail oriented with the ability to exercise independent judgment.
• Interpersonal Effectiveness: Developed interpersonal skills, emotional intelligence, diplomacy, tact, conflict management, delegation skills, and diversity awareness. Ability to work effectively with sensitive and confidential material and sometimes emotionally charged matters.
• Communication Skills: Good command of the English language. Second language is an asset but not required. Effective communication skills (oral, written, presentation), is an active listener, and effectively provides balanced feedback.
• Self-Management: Effectively manages own time, conflicting priorities, self, stress, and professional development. Self-motivated and self-starter with ability to work independently with limited supervision. Ability to work remotely effectively as required.
• Must be able to work effectively in a fast-paced, multi-site environment with demonstrated ability to juggle competing priorities and demands from a variety of stakeholders and sites.
• Computer Skills:
• Proficiency in MS Office Word, Excel, Power Point, and Outlook required.
• Travel : 0% Standard Core Workdays/H

Benefits

Additional Information

Location: Remote Position Pay Range: $18.93 - $31.56

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