Insurance Representative 2 - (US) - Prior Authorization Spec FRx
Company: Fresenius Medical Care North America
Location: Mesa
Posted on: August 6, 2022
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Job Description:
**PURPOSE AND SCOPE:**
Reviews, verifies, and processes prior authorizations in the
pharmacy management system's work queue. Serves as a resource to
patients, dialysis facility personnel, and other Fresenius Medical
Care employees for prior authorizations.
**PRINCIPAL DUTIES AND RESPONSIBILITIES:**
+ Under general supervision, follows established company policies
and procedures and applies acquired job skills to verify insurance
rejections and contact clinics to initiate and receive information
to complete prior authorizations for patients.
+ Assists clinics and patients with understanding prior
authorizations and their pharmacy benefits.
+ Educates patients regarding requirement for insurance plan to
complete prior authorization.
+ Answers inbound inquires related to prior authorizations and
insurance claims.
+ Completes outbound calls to payors and clinics to assist with
prior authorizations.
+ Verifies insurance coverage by phone, online or through E1
(electronic system) transactions for all new patients and/or
changes in coverage.
+ Enters patient insurance information under the patient's account
in the pharmacy data system.
+ Ability to review multiple pharmacy management platforms
simultaneously to complete daily tasks.
+ Demonstrates knowledge and understanding of insurance billing and
prior authorization requirements demonstrating analytical
thinking.
+ Monitors all patients' prior authorizations to ensure that it is
initiated and progressing through the pharmacy management
system.
+ Performs functions that require full knowledge of general aspects
of the job.
+ Works on assignments that are semi-routine in nature, but
recognizes the need for occasional deviation from accepted
practice.
+ Escalates issues to supervisor or appropriate department for
resolution, as deemed necessary.
+ Reviews and complies with the Code of Business Conduct and all
applicable company policies and procedures, local, state and
federal laws and regulations.
+ Assists with various projects as assigned by direct
supervisor.
+ Other duties as assigned.
**_Additional responsibilities may include focus on one or more
departments or locations. See applicable addendum for department or
location specific functions._**
**PHYSICAL DEMANDS AND WORKING CONDITIONS** **:**
+ The physical demands and work environment characteristics
described here are representative of those an employee encounters
while performing the essential functions of this job. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.
**SUPERVISION:**
+ None
**EDUCATION** **:**
+ High School Diploma required
**EXPERIENCE AND REQUIRED SKILLS:**
+ 1 - 2 years' related experience
**EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual
Orientation/Gender Identity**
**Fresenius Medical Care North America maintains a drug-free
workplace in accordance with applicable federal and state
laws.**
Keywords: Fresenius Medical Care North America, Mesa , Insurance Representative 2 - (US) - Prior Authorization Spec FRx, Other , Mesa, Arizona
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