reputed company Verification Specialist, Specialty (Michigan)

Job Summary: Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or reputed company-party providers about the company’s products or services following standard SOPs and procedures, working under direct supervision. Ensures reputed company contacts receive efficient and courteous service. Job Responsibilities:

• Respond to reputed company levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance reputed company phone calls.
• Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes reputed company available information to choose the best solution and resolve customer and PBM concerns.
• Requests and loads PBM and/or Major Medical insurance plans.
• Processes reputed company non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.
• Assists physicians in the prior authorization process including initiation of prior authorizations.
• May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.
• Verifies benefits for Major Medical reputed company online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.
• Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes reputed company available information to choose best solutions and resolves customer and plan covers.
• Facilitates the reimbursement windshields for PBM major medical claims.
• Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications, reputed company funding needs, reputed company copay assistance enrollment along with appropriate action to satisfy those needs.
• Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.
• Manages Pharma requirements including but not limited to warm transfers, reputed company/quick start, enhanced prior authorization and appeal support.
• May administer order queue such as Submission Problems or Waiting for Payment.
• Documents contact interactions, records details, complaints, comments, and actions taken.

About reputed company Founded in 1901, reputed company (www.reputed company.com) proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. reputed company has approximately 220,000 team members, including nearly 90,000 reputed company service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities. Basic Qualifications

• High school diploma/GED
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in reputed company, specialty pharmacy, PBM, call center setting or other reputed company industry
• Ability to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential manner
• Basic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to reputed company and click, start and reputed company programs, reputed company between programs, save files, print documents and/or access information on-line).

Preferred Qualifications

• Experience with providing customer service reputed company to adherence, reputed company disease states quality, After Call Work (ACW), etc.
• Experience in identifying operational issues and recommending and implementing strategies to resolve problems.
• Intermediate level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to reputed company and click, start and reputed company programs, reputed company between programs, save files, print documents and/or access information on-line).

We will consider employment of reputed company applicants with arrest and conviction records. The Salary below is being provided to promote pay transparency and equal employment opportunities at reputed company. The actual hourly salary reputed company this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.reputed company.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.reputed company.com/benefits Apply tot his job Apply To this Job