¨ cts as a resource to the facilities in obtaining information, completing necessary documentation, and following up on outstanding claims.
¨ Understands Insurance and Medicaid formularies and processes, including the prior authorization processes.
¨ Makes outgoing calls to Facilities, Plans, and Physician’s offices as needed to obtain approvals
¨ Works with Client Billing Service Offices, Pharmacy Directors, customers and prescription drug plans to effectively communicate and resolve customer issues.
¨ Provides clinical support to members of the RxAllow team regarding prior authorization concerns
¨ Achieves productivity goals with regard to calls/claims per hour, as determined by the Director and Clinical Hub Manager.
¨ Prioritizes work to meet daily and competing deadlines.
¨ Develops a strong understanding of the insurance verification, adjudication, back-end billing process and become a subject matter expert on the insurance queues and billing workflow.
¨ Maintains a clean and organized work area.
¨ Performs other tasks as assigned.
¨ Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Medical Recruitment Startegies