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Accredo - Patient Access Representative I Accredo - Patient Access Representative I Full Time, Work From Home Express Scripts | Orlando, FL YESTERDAY POSITION SUMMARY: The Patient Access Representative I verifies/ re-verifies insurance eligibility and obtains prior authorization and additional information required by the payer for proper billing. Confers with patients regarding insurance eligibility/benefits and educates patients on their financial obligation once coverage is verified. The successful Patient Access Representative I must demonstrate strong sensitivity to customer needs and commitment to quality and work quickly in order to process insurance paperwork in a timely manner. ESSENTIAL FUNCTIONS: Performs insurance verification and re-verification of insurance. Communicates in writing or via telephone with patients, family members, physicians and insurance representatives on eligibility requirements, policy benefits, eligibility determinations and contract provisions. Maintains accurate and complete documentation of all contacts. Receive, sort, identify, stamp and log faxed/mailed prior authorization requests. May distribute incoming mail and fax correspondence to physicians. Provides administrative support to the prior authorization team including updating and maintaining forms used by the department. Review co-pay assistance program information to perform verification for patient eligibility by contracting programs to confirm funding information. Completes other projects and additional duties as assigned.QUALIFICATIONS: High school diploma or GED required, bachelor’s degree preferred 0-1 years of relevant working experience; health insurance experience with medical insurance knowledge and terminology is preferred Intermediate data entry skills and working knowledge of Microsoft Office Excellent telephone presentation and communication skills. Demonstrated ability to handle challenging customers in a professional manner with the ability to adapt in a dynamic work environment. Solid problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions. *LI-EV1Job CategoryOperationsPrimary LocationUnited States-Florida-OrlandoWork LocationsOrlando, FL - 6272 Lee Vista Boulevard6272 Lee Vista BlvdOrlando32822ScheduleFull-timeShift1st ShiftEmployee StatusRegularTravelNoWork From Home?No Internal ID: REQ20003444 YESTERDAY
Accredo - Patient Access Representative III Accredo - Patient Access Representative III Full Time, Part Time... Express Scripts | Warrendale, PA 2 DAYS AGO The Patient Access Representative III performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership’s knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals and provide accurate status reporting to clients. SCOPE OF JOB Contacts are frequent with individuals representing other internal departments as well as outside client groups including physicians, payers, pharma and patients. Contacts involve obtaining or providing confidential and/or time sensitive information on matters of high importance to the functioning of the department. Errors may be difficult to detect and would normally result in loss of revenue, client abrasion or patient dissatisfaction. Exercise high level of independent judgement. Knowledge and Abilities: Extensive knowledge of ESI products and services a must; Experience training and coaching less experienced staff with patience to explain details and processes repeatedly; Excellent phone presentation and communication skills; Demonstrated ability to handle challenging customers in a professional manner; Ability to adapt in a dynamic work environment and make decisions with minimal supervision; Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutionsCompletes other projects and additional duties as assigned Contacts benefit providers to gather policy benefits/limitations; coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.). Directly interfaces with external clients. Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization. May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome. Handle Escalations. Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate. Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients. Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients. Provide expert assistance to clients on patient status. Liaison for company providing referral status reporting.GED: General Studies (Required) HS: General Studies (Required) Years of Relevant Work Experience 3 - 5 YearsJob CategoryOperationsPrimary LocationUnited States-Pennsylvania-WarrendaleWork LocationsWarrendale, PA - 3000 Ericsson Drive3000 Ericsson DriveWarrendale15086ScheduleFull-timeShift1st ShiftEmployee StatusRegularTravelNoWork From Home?No Internal ID: REQ20001364 2 DAYS AGO
Accredo - Patient Access Representative III Accredo - Patient Access Representative III Full Time, Part Time... Express Scripts | Orlando, FL 2 DAYS AGO POSITION SUMMARY: The Patient Access Representative III performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership’s knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals and provide accurate status reporting to clients. ESSENTIAL FUNCTIONS: Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization. Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients. Contacts benefit providers to gather policy benefits/limitations; coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.). Directly interfaces with external clients. Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients. Provide expert assistance to clients on patient status. Liaison for company providing referral status reporting. May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome. Handle Escalations. Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate. Completes other projects and additional duties as assigned.QUALIFICATIONS: High school diploma or GED required, bachelor’s degree preferred 3-5 years of relevant working experience; Health care experience with medical insurance knowledge and terminology and experience in patient access preferred Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge *LI-EV1Job CategoryOperationsPrimary LocationUnited States-Florida-OrlandoOther LocationsUnited States-Pennsylvania-WarrendaleWork LocationsOrlando, FL - 6272 Lee Vista Boulevard6272 Lee Vista BlvdOrlando32822ScheduleFull-timeShift1st ShiftEmployee StatusRegularTravelNoWork From Home?No Internal ID: REQ20002957 2 DAYS AGO