Amber Pharmacy, Enrollment Specialist - Full Time
Company Name:
Hy-Vee Food Stores
Page 1 Job Descriptio n Enrollment Specialist Department: Customer Accounts Department Job Relationships: (cid:1) (cid:1) Reports to: Manager, Customer Accounts Supervises: N/A Job Functions: Responsible for insurance verification of new referrals, and relaying statistical information of verification to the Director of Patient Enrollment. Communicate with nurses, coordinators, and co-workers regarding insurance verification as to promote exceptional customer service and professionalism within the community. Job
Responsibilities: General duties include but are not limited to: 1. Responsible for entry of pertinent information into system for all new referrals. 2. Must be knowledgeable of Medicare, Medicaid, Commercial insurances, and renal programs and how they apply to transplant and specialty patients. 3. Responsible for obtaining accurate insurance verification of all patient insurances within the assigned two hour turnaround time. 4. Must be detail oriented and maintain a high level of accuracy. 5. Must maintain the established workflow within the patient enrollment department and adhere to the company/ departments Policy and Procedure manual. 6. Ensures that pertinent verification information is relayed to the Director for reporting to internal company departments, and for addition to department spreadsheets. 7. Must complete verification forms to ensure the necessary documentation is in place for new referral insurance verification and reimbursement. 8. Distributes and communicates information regarding new referrals to appropriate departments. 9. Responsible for reversing and voiding all test claims. 10. Responsible for informing appropriate internal departments of any patient/coordinator circumstance that could potentially become a problem situation. 11. Must be knowledgeable about prior authorizations and follow the department policy and protocol for prior authorizations. 12. Must be knowledgeable about patient assistance programs and follow department policy and protocol for patient assistance programs. 13. Works on re-verification of insurance due to Medicare flip dates. Verifies all new patient insurances, and ensures all are done on a timely basis and reported to internal departments when applicable. 14. Solves pharmacy denied adjudicated claims, when applicable. ENROLLMENT SPECIALIST Page - 1 Amber Enterprises, Inc. dba Amber Pharmacy June 19, 2014 Page 2 15. Responsible for contacting the appropriate drug company in regards to any defective specialty medication in which a replacement is required. 16. Responsible for contacting the company nurse, or nursing agency, when a home teaching is requested. 17. Contacts patients, when applicable, to inform of insurance benefits, and arrange initial shipment of medication(s). 18. Ensures that proper ICD-9, and HCPCS codes are added to correspondence for specialty patients as required by insurance companies. 19. Contacts referring nurses/coordinators according to assigned team regarding insurance verification findings and patient issues. 20. Responsible for informing Senior Enrollment Specialist and/or Manager of any special handling information for assigned team and ensuring compliance for all special handling situations. 21. Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual. 22. Maintains professionalism at all times and works as a team member with all other employees in a courteous, respectful and cooperative manner. Minimum Qualifications: Education: Education: High school Education: Education:
Experience:
Experience:
Experience:
Experience: Prior authorizations Prior insurance verification (cid:1) Medicare, Medicaid and Commercial Insurance related to pharmacy billing. (cid:1) (cid:1) (cid:1) Microsoft Office computer applications (cid:1) Medical Terminology
Qualifications: (cid:1) Demonstrates ability to take direction, work well with others, and work in a team environment. (cid:1) (cid:1) (cid:1) Excellent customer service skills. Effective verbal and written communication skills. Effectively works in a fast paced environment. Physical Requirement: (cid:1) (cid:1) (cid:1) In an 8 hour day the employee may be asked to lift/carry 10 lbs. In an 8 hour day the employee may stand/walk approximately 1 hour. In an 8 hour day the employee sits approximately 7 hours. This list is in no way to be used as an all-encompassing list of duties. The intention of the aforementioned job description is to be used as a guide to assist in accomplishing company and department objectives, covering only primary functions and responsibilities. Approved By: Manager __________________________________________________________________________ Date __________ Employee _________________________________________________________________________ Date __________ ENROLLMENT SPECIALIST Page - 2 Amber Enterprises, Inc. dba Amber Pharmacy June 19, 2014Estimated Salary: $20 to $28 per hour based on qualifications.
Hy-Vee Food Stores
Page 1 Job Descriptio n Enrollment Specialist Department: Customer Accounts Department Job Relationships: (cid:1) (cid:1) Reports to: Manager, Customer Accounts Supervises: N/A Job Functions: Responsible for insurance verification of new referrals, and relaying statistical information of verification to the Director of Patient Enrollment. Communicate with nurses, coordinators, and co-workers regarding insurance verification as to promote exceptional customer service and professionalism within the community. Job
Responsibilities: General duties include but are not limited to: 1. Responsible for entry of pertinent information into system for all new referrals. 2. Must be knowledgeable of Medicare, Medicaid, Commercial insurances, and renal programs and how they apply to transplant and specialty patients. 3. Responsible for obtaining accurate insurance verification of all patient insurances within the assigned two hour turnaround time. 4. Must be detail oriented and maintain a high level of accuracy. 5. Must maintain the established workflow within the patient enrollment department and adhere to the company/ departments Policy and Procedure manual. 6. Ensures that pertinent verification information is relayed to the Director for reporting to internal company departments, and for addition to department spreadsheets. 7. Must complete verification forms to ensure the necessary documentation is in place for new referral insurance verification and reimbursement. 8. Distributes and communicates information regarding new referrals to appropriate departments. 9. Responsible for reversing and voiding all test claims. 10. Responsible for informing appropriate internal departments of any patient/coordinator circumstance that could potentially become a problem situation. 11. Must be knowledgeable about prior authorizations and follow the department policy and protocol for prior authorizations. 12. Must be knowledgeable about patient assistance programs and follow department policy and protocol for patient assistance programs. 13. Works on re-verification of insurance due to Medicare flip dates. Verifies all new patient insurances, and ensures all are done on a timely basis and reported to internal departments when applicable. 14. Solves pharmacy denied adjudicated claims, when applicable. ENROLLMENT SPECIALIST Page - 1 Amber Enterprises, Inc. dba Amber Pharmacy June 19, 2014 Page 2 15. Responsible for contacting the appropriate drug company in regards to any defective specialty medication in which a replacement is required. 16. Responsible for contacting the company nurse, or nursing agency, when a home teaching is requested. 17. Contacts patients, when applicable, to inform of insurance benefits, and arrange initial shipment of medication(s). 18. Ensures that proper ICD-9, and HCPCS codes are added to correspondence for specialty patients as required by insurance companies. 19. Contacts referring nurses/coordinators according to assigned team regarding insurance verification findings and patient issues. 20. Responsible for informing Senior Enrollment Specialist and/or Manager of any special handling information for assigned team and ensuring compliance for all special handling situations. 21. Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual. 22. Maintains professionalism at all times and works as a team member with all other employees in a courteous, respectful and cooperative manner. Minimum Qualifications: Education: Education: High school Education: Education:
Experience:
Experience:
Experience:
Experience: Prior authorizations Prior insurance verification (cid:1) Medicare, Medicaid and Commercial Insurance related to pharmacy billing. (cid:1) (cid:1) (cid:1) Microsoft Office computer applications (cid:1) Medical Terminology
Qualifications: (cid:1) Demonstrates ability to take direction, work well with others, and work in a team environment. (cid:1) (cid:1) (cid:1) Excellent customer service skills. Effective verbal and written communication skills. Effectively works in a fast paced environment. Physical Requirement: (cid:1) (cid:1) (cid:1) In an 8 hour day the employee may be asked to lift/carry 10 lbs. In an 8 hour day the employee may stand/walk approximately 1 hour. In an 8 hour day the employee sits approximately 7 hours. This list is in no way to be used as an all-encompassing list of duties. The intention of the aforementioned job description is to be used as a guide to assist in accomplishing company and department objectives, covering only primary functions and responsibilities. Approved By: Manager __________________________________________________________________________ Date __________ Employee _________________________________________________________________________ Date __________ ENROLLMENT SPECIALIST Page - 2 Amber Enterprises, Inc. dba Amber Pharmacy June 19, 2014Estimated Salary: $20 to $28 per hour based on qualifications.
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