Express Scripts Holding Company
Insurance Reimbursement Spec.
Requires moderate problem solving skills to troubleshoot claims issues and resolve in order to avoid shipment delay to patient. An unshipped order equates to approximately $3,700 in revenue as well as negatively impacts patient care. While the level of risk is moderate to revenue, the risk of non-compliance to the REMS requirements is high as it impacts both contractual and regulatory requirements.
Determine program eligibility. Verify patient benefits for all assigned patients within program required timeframes. Facilitate prior authorization process within the required timeframes. Communicate patient responsibility timely and accurately. Asses and refer appropriately for special programs when available.
Act as single point of contact for an assigned group of prescribers. Effective and timely communication with prior authorization and/or patient enrollment status.
Complete accurate entry of billing information to ensure timely payment and avoid delay in patient therapy. Communicate with payers for claim rejection resolution.
Identify and report events as required based on the REMS requirements for specified medication. Recognize potential adverse event and forward caller/written information to a clinical team member for reporting to the manufacturer. Recognize a product quality complaint and forward caller/written information to a pharmacist for reporting to the manufacturer. Recognize potential risk events and forward the caller/written information to a pharmacist for assessment and reporting to the manufacturer.
Accurate and timely documentation of payer, billing information and patient status within the operations systems.
HS degree or equivalent; Minimum of 2 years secondary education preferred
4-6 years relevant experience in pharmacy benefit management; Previous insurance experience preferred
Basic computer knowledge – Microsoft Word and Excel; AS400 a plus
Knowledge of medical terminology and claims processing jargon
Excellent written/verbal communication to include providing clear instructions
Ability to multitask
ABOUT THE DEPARTMENT
Through the range of healthcare products and services Accredo offers, team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiencies. In addition to the wide range of healthcare products offered to these patients, we provide comprehensive management services, including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. In these very high-touch roles, employees leave every day knowing they made a positive impact on patient lives.
ABOUT EXPRESS SCRIPTS
Advance your career with the company that makes it easier for people to choose better health.
Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the Most Admired Companies in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.
Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.
Express Scripts Holding Company
Website : http://www.express-scripts.com
Abbott Diabetes Care communicated a recall of certain FreeStyle® strips used in the FreeStyle® Blood Glucose Meter built into the OmniPod Personal Diabetes Manager (PDM). They have also recalled the FreeStyle Flash® Meter and FreeStyle® Classic meters. Both recalls are being issued because glucose level readings using these products may provide erroneously low results which if not recognized may pose significant risks to your health.