POSITION SUMMARY:
The Benefit Verification Coordinator is responsible for the coordination and processing of patient medication orders, to include order intake within regulatory boundaries, customer service coordination, and pharmacy technician duties as defined by policy and regulation and while under the supervision of a pharmacist.
POSITION RESPONSIBILITIES:
Provide high quality customer service to patients and prescribers while protecting patient confidentiality.
Verify information on prescriptions received prior to processing (correct prescriber, name of patient, patient information, medication, dose, quantity, number of refills).
Effectively use our internal pharmacy management software, PrimeRx, to complete claims processing and prior authorizations.
Perform patient level benefits verifications as applicable for all pharmacy benefits plans.
Complete prior authorization templates per payer requirements to ensure medication orders will be covered by insurance plans.
Evaluate all completed prior authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations.
Processing of prior authorization responses via CoverMyMeds and submitting appeals if requested by patient/prescriber.
Communicate as necessary with patients to determine general health status, medication compliance, medication and supply inventory, and overall coordination of care and service (custom assessment in software system) as applicable.
Make outbound calls to prescribers, patients, and insurance companies.
Assist with inbound calls as needed for respective program(s).
Perform follow up on all outstanding prior authorizations/orders while following program specific correspondence for patient/prescriber/insurance.
Adhere to program specific rules and timelines when processing orders.
Prepare and maintain patient profile, medication administration records, and other documents as needed when setting up orders for shipment.
Perform all other duties as assigned.
REQUIRED EDUCATION AND EXPERIENCE:
High School diploma or equivalent
Two (2) years of experience providing customer service to internal and external customers, including meeting quality standards for services
Registered and licensed pharmacy technician by the Kentucky and/or Indiana Board of Pharmacy in good standing or ability to obtain license during onboarding.
Advance knowledge of medical terminology (including sig codes and Roman numerals), brand and generic names of medications, and general pharmacy terminology
Ability to read, write, speak, and understand the English language
PREFERRED EDUCATION AND EXPERIENCE:
6 months customer service experience, payer benefits experience with reimbursement and prior authorizations, healthcare industry experience, license, or equivalent coursework.
Nationally certified through the PTCB or another approved certifying agency
Experience with HIPAA and patient services
Knowledge of insurance procedures
KNOWLEDGE, SKILLS & ABILITIES:
Excellent organization skills and detail oriented
Demonstrated empathy and compassion
Excellent verbal and written communication skills
Balance multiple priorities to meet expected response deadlines
Adaptable, flexible, and readily adjust to changing situations
Ability to work independently and as a member of a team
Ability to comprehend and apply basic math principles
Ability to apply logical thinking when evaluating practical problems
Ability to present information and respond to questions from stakeholders
Ability to interact with a diverse group
Ability to listen and demonstrate a high degree of empathy
Demonstrated computer skills includes Microsoft Word, Excel, and Outlook
Display tact and diplomacy in response to unfavorable or negative situations
Demonstrated sensitivity and understanding when speaking with patients
Demonstrated passion for speaking with people in an outgoing way
PHYSICAL REQUIREMENTS:
Location of job activities 100% inside
Noise and / or vibrations exposure
While performing the duties of this job, the employee is regularly required to talk or hear
Stand and sit for prolonged periods of time
This job operates in a professional office environment that uses standard office equipment such as computers, phones, and printers
