Eligibility Specialist
Express-Scripts - Florida

This job posting is no longer available on Express Scripts. Find similar jobs: Eligibility Specialist jobs - Express-Scripts jobs

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, MDO's, 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.

1. Review incoming referrals for completeness of and confirm FDA requirements are met. These are typically received via facsimile, Web portal or client partner download. Answer all Incoming calls on Hotline quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team.

2. Complete verification of Benefits and Eligibility for all referrals from patients, MDO¿s, health plans and pharmaceutical manufacturers. Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy.

3. Take referral via phone which includes completing the referral form, giving the caller an overview of our process and timeframes and ensuring we have all necessary information to work a case.

4. Effectively manage and work though action item list to ensure it is current and tasks are completed in a timely fashion.

5. 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.

6. Other duties as needed.

7. 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.

QUALIFICATIONS

Bachelor' Degree preferred.
Minimum High School Diploma or GED equivalent required. Bachelor' Degree preferred.

Five or more years experience in the insurance, biotechnology, or pharmaceutical industries, in customer service and/or reimbursement.

Health Insurance claims or patient accounting experience a plus.

Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals required.

Computer proficiency in MS Office applications, with database experience a plus.

Detail oriented with good analytical skills.

Ability to manage multiple priorities and meet deadlines.

Excellent written and verbal communication skills, with demonstrated successful ability to communicate with others at all levels.

EEO STATEMENT

Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.

None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.

Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.

Express Scripts - 20 months ago - save job - copy to clipboard
About this company
791 reviews
Express Scripts is a Fortune 25 company and is the largest pharmacy benefit manager in the U.S.