CVS Health
Chandler, Arizona, United States
Benefits Verification Representative
Posted over 1 month ago
Job Description
Job Description
The primary responsibilities are to verify insurance coverage and perform benefit investigation for both new and existing patients in order to process patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. This role will require an understanding of insurance carriers and concepts including drug cards, major medical benefits, and per diem coverage as well as knowledge of government and patient assistance programs.
1) Collect appropriate information needed to ensure insurance coverage for patient medication orders.
* Responsible for accurate and timely verification of new and existing patients prescription drug coverage specifically relating to disease state and type of prescriptions, supplies and services requested.
* Disposition and deny cases appropriately.
* Conduct benefit investigations and obtain prior authorizations when needed.
* Contact insurance carriers to resolve Electronic Claim Submission (ECS) rejections and other insurance related issues.
* Verify patient coverage with insurance companies.
* Secure and verify a method of payment (MOP) for patients financial responsibility to prevent company bad debt.
2) Communicate with healthcare professionals to obtain necessary information and provide feedback on status of patients medication and coverage.
* Contact doctors offices for information to help resolve outstanding claims or insurance issues.
* Follow all procedures for payers and manufacturer programs to ensure all contractual obligations are met.
3) Communicate with patient regarding order status and possible information needed to resolve coverage issues.
* Obtain or validate accurate patient information including diagnosis, insurance and financial information to complete enrollment applications for new patients.
* Appropriately document patient financial responsibility for the pharmacy.
Required Qualifications
Six months experience working with medical insurance, benefits verification, medical billing, or a related field.
1+ years of experience in a Windows based computer utilizing Microsoft Office.
Preferred Qualifications
Pharmacy, PBM or Specialty pharmacy experience
* Knowledge of government and patient assistance programs
* Excellent customer service skills
* Attention to detail
* Analytical and problem solving skills
* Experience working with medical billing procedure
* Previous experience working with Prior Authorizations
* Knowledge of Medicare, Medicaid, and third party vendors
Education
High School Diploma or GED required
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
The primary responsibilities are to verify insurance coverage and perform benefit investigation for both new and existing patients in order to process patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. This role will require an understanding of insurance carriers and concepts including drug cards, major medical benefits, and per diem coverage as well as knowledge of government and patient assistance programs.
1) Collect appropriate information needed to ensure insurance coverage for patient medication orders.
* Responsible for accurate and timely verification of new and existing patients prescription drug coverage specifically relating to disease state and type of prescriptions, supplies and services requested.
* Disposition and deny cases appropriately.
* Conduct benefit investigations and obtain prior authorizations when needed.
* Contact insurance carriers to resolve Electronic Claim Submission (ECS) rejections and other insurance related issues.
* Verify patient coverage with insurance companies.
* Secure and verify a method of payment (MOP) for patients financial responsibility to prevent company bad debt.
2) Communicate with healthcare professionals to obtain necessary information and provide feedback on status of patients medication and coverage.
* Contact doctors offices for information to help resolve outstanding claims or insurance issues.
* Follow all procedures for payers and manufacturer programs to ensure all contractual obligations are met.
3) Communicate with patient regarding order status and possible information needed to resolve coverage issues.
* Obtain or validate accurate patient information including diagnosis, insurance and financial information to complete enrollment applications for new patients.
* Appropriately document patient financial responsibility for the pharmacy.
Required Qualifications
Six months experience working with medical insurance, benefits verification, medical billing, or a related field.
1+ years of experience in a Windows based computer utilizing Microsoft Office.
Preferred Qualifications
Pharmacy, PBM or Specialty pharmacy experience
* Knowledge of government and patient assistance programs
* Excellent customer service skills
* Attention to detail
* Analytical and problem solving skills
* Experience working with medical billing procedure
* Previous experience working with Prior Authorizations
* Knowledge of Medicare, Medicaid, and third party vendors
Education
High School Diploma or GED required
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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