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Express Scripts Holding Company

Insurance Reimbursement Specialist UBC

Express Scripts Holding Company - Saint Louis, MO

Insurance Reimbursement Specialist UBC

in

Saint Louis

Missouri

POSITION SUMMARY The Insurance Reimbursement Specialist is primarily responsible for verifying insurance benefits, obtaining prior authorizations and reauthorizations and validating accurate billing information to ensure claims are paid for drug shipment. Accurate documentation of payer information and patient status. Daily communication with patients, payers and physician offices regarding program status and financial responsibility. Assessment for ancillary program Voucher, Coupon, PAP eligibility with available. Understanding of the Risk Evaluation and Mitigation Strategies REMS program and report per product specific requirements. Identify potential adverse events and transfer to a clinical program member ESSENTIAL FUNCTIONS * 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. QUALIFICATIONS * FORMAL EDUCATION AND/OR TRAINING: * HS degree or equivalent. * Minimum of 2 years secondary education preferred * 4-6 years relevant experience in pharmacy benefit management. * Previous insurance experience preferred. * Pharmacy Technician. * 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 Company 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, 401k 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..Employer's Job# ESMEUS2032Please visit job URL for more information about this opening and to view EOE statement.

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13 days 1 hour ago

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Insurance Reimbursement Specialist UBC Express Scripts Holding Company - Saint Louis, MO, United States

   

Location: Saint Louis, MO

Company Profile:
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.