Healthcare CSR

Careerbuilder US in Monroeville, PA

  • Industry: Healthcare - Allied Health - Medical Biller/Coder
  • Type: Full Time
  • $216,800.00 - 216,800.00
position filled
The primary responsibilities are to verify insurance coverage for potential new patients and re-verify insurance coverage for existing patients in order to process patient prescription needs successfully and demonstrate excellent customer service to patients, healthcare professionals and insurance carriers. The Company's CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Company's as the client and in accordance with Medicare Part D CMS Regulations. Must apply information [provided through multiple channels] to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
Associated topics: cbo, clerk, coder, coding, data, front desk, medical coder, number, receivable, review

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