The Patient Access Representative II is dedicated to meeting the expectations and requirements of internal and external customers by obtaining required patient, payer and physician documentation, verifying insurance benefits, completing shipments and documenting all transactions in the system. As necessary, the Patient Access Representative II may also perform quality audits and negotiate pricing. This position requires highly developed interpersonal and communication skills to successfully interact with patients, pharma, physicians and payers to complete the verification process.
Performs all aspects of electronic claims process and rejection resolution.
Ensures accounts requiring authorizations and re-authorizations are identified, secured, and updated in RX Home prior to each shipment. Notifies as appropriate if authorization cannot be obtained.
Contacts benefit providers to gather policy benefits/limitations to ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
Handles inbound client calls and written correspondence regarding patient eligibility.
Provides inbound phone call support to the prior authorization team giving personal attention to the resolution of customer issues having to do with the status of letter requests or physician review process.
Supports cross-functional departments in resolution of eligibility issues (claims, contact center, account management, service delivery, etc.)
Negotiates pricing for non-contracted payers and authorizes patient services and ensures proper pricing is indicated in RxHome. Works referrals.
Completes other projects and additional duties as assigned
High school diploma or GED required, bachelor's degree preferred
2-3 years of relevant working experience to include one year of health care experience with medical insurance knowledge and terminology
Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge
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 solutions
Would you like to learn more about this role? Please CLICK HERE to learn more about the Patient Access Representative in Memphis.
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
At Express Scripts, we dare to imagine a better health care system, and we're driven to make it happen. Where some see obstacles, we see possibilities. We're challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.
We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes like no one else can. We believe health care can do more. We are Champions For BetterSM.
Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.