Fertility Insurance Verification Specialist
Schraft's 2.
0 Pharmacy Schraft's 2.
0 Pharmacy Cedar Knolls, NJ Cedar Knolls, NJ Full-time Full-time From $20 an hour From $20 an hour 2 days ago 2 days ago 2 days ago Essential Duties and
Responsibilities:
The insurance verification specialist processes and reviews prior authorization requests and failed adjudication for medications for clinical appropriateness.
This assures members receive the most effective and cost-effective pharmacological therapies.
All applicable discounts are added, reviewed and properly applied to each order which will also include clear and accurate documentation and explanation of benefits.
Processes prior authorizations for patient medication and other clinical needs.
Communicates with patients and referring doctor offices to get correct insurance eligibility, medical records and pharmacy benefit information.
Applies Medical Policy Criteria to prior authorization requests and evaluates whether request meets criteria for approval.
Reviews the request using professional judgment on a case by case basis.
A pharmacist will review medication requests not addressed by criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
Communicates to Pharmacists and other medical staff regarding prior authorizations and pre-certifications, especially if a medication has been denied authorization.
Creates and maintains highly organized filing system for all documents, invoices, training material, client accounts, and reference materials.
Records and processes orders and/or inquiries received by mail, telephone, and/or through direct patient contact.
Provides timely response to patients' inquiries.
Provides pricing, availability, and schedules information within established guidelines.
Provides new and existing patients with the best possible customer service in relation to their drug prescriptions, clinical services, billing inquiries, patients' suggestions and complaints.
Ensures that good patients' relations are maintained; patients' claims, and complaints are resolved fairly and effectively.
Contacts the pharmacists to alert them of any changes in patient's condition, compliance issues due to patient not taking medication or side effects, or to transfer a patient directly to pharmacist for counseling.
Properly identifies, adds, and adjudicates insurance for each claim and provide proper documentation in regard to out of pocket expenses, deductibles, and all other applicable information.
Performs additional duties as needed Education and/or Work Experience Requirements:
Bachelor's degree in healthcare or related field 5
years of experience in pharmacy environment, including responsibility for prior authorization preferred.
Knowledge of PBM industry/managed care industry/pharmaceutical manufacturing industry.
Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers Excellent computer proficiency (MS Office - Word, Excel and Outlook) Experience with project management tool preferred Physical Requirements:
Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards Must be able to lift and carry up to 25 lbs Must be able to talk, listen and speak clearly on telephone Job Type:
Full-time Pay:
From $20.
00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance
Experience:
Insurance Verification:
1 year (Preferred) Fertility Terminology:
1 year (Preferred) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
0 Pharmacy Schraft's 2.
0 Pharmacy Cedar Knolls, NJ Cedar Knolls, NJ Full-time Full-time From $20 an hour From $20 an hour 2 days ago 2 days ago 2 days ago Essential Duties and
Responsibilities:
The insurance verification specialist processes and reviews prior authorization requests and failed adjudication for medications for clinical appropriateness.
This assures members receive the most effective and cost-effective pharmacological therapies.
All applicable discounts are added, reviewed and properly applied to each order which will also include clear and accurate documentation and explanation of benefits.
Processes prior authorizations for patient medication and other clinical needs.
Communicates with patients and referring doctor offices to get correct insurance eligibility, medical records and pharmacy benefit information.
Applies Medical Policy Criteria to prior authorization requests and evaluates whether request meets criteria for approval.
Reviews the request using professional judgment on a case by case basis.
A pharmacist will review medication requests not addressed by criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
Communicates to Pharmacists and other medical staff regarding prior authorizations and pre-certifications, especially if a medication has been denied authorization.
Creates and maintains highly organized filing system for all documents, invoices, training material, client accounts, and reference materials.
Records and processes orders and/or inquiries received by mail, telephone, and/or through direct patient contact.
Provides timely response to patients' inquiries.
Provides pricing, availability, and schedules information within established guidelines.
Provides new and existing patients with the best possible customer service in relation to their drug prescriptions, clinical services, billing inquiries, patients' suggestions and complaints.
Ensures that good patients' relations are maintained; patients' claims, and complaints are resolved fairly and effectively.
Contacts the pharmacists to alert them of any changes in patient's condition, compliance issues due to patient not taking medication or side effects, or to transfer a patient directly to pharmacist for counseling.
Properly identifies, adds, and adjudicates insurance for each claim and provide proper documentation in regard to out of pocket expenses, deductibles, and all other applicable information.
Performs additional duties as needed Education and/or Work Experience Requirements:
Bachelor's degree in healthcare or related field 5
years of experience in pharmacy environment, including responsibility for prior authorization preferred.
Knowledge of PBM industry/managed care industry/pharmaceutical manufacturing industry.
Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers Excellent computer proficiency (MS Office - Word, Excel and Outlook) Experience with project management tool preferred Physical Requirements:
Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards Must be able to lift and carry up to 25 lbs Must be able to talk, listen and speak clearly on telephone Job Type:
Full-time Pay:
From $20.
00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance
Experience:
Insurance Verification:
1 year (Preferred) Fertility Terminology:
1 year (Preferred) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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