What are the responsibilities and job description for the Enrollment Representative - Benefits Investigation position at CarepathRx?
CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.
Job Details:
The Benefit Investigator gathers all necessary insurance benefits information and prepares the appropriate documentation in adherence with the BioPlus 2-hour brand promise. The Benefit Investigator strives to work efficiently and accurately to provide appropriate and timely information to other departments.
Responsibilities
Responsible for accurately completing benefit investigations with adherence to company’s 2-hour brand promise.
Must be proficient in:
Pharmacy benefits
Major medical
Commercial insurance
Medicare Parts A, B, C and D
Supplemental Plans
Medicaid
VA (Veterans Affairs Benefits), DOD (Department of Defense), FEHB (Federal Employees Health Benefits)
Responsible for a complete understanding of health insurance benefit structure including copay structure, co-insurance, deductibles, out of pocket, coordination of benefits, etc.
Adjudicate claims through Pharmacy Benefit Managers.
Ability to read and understand paid and rejected claims.
Ability to be able to read Rx and select appropriate dose/units per day supply.
Must have great customer service phone skills with the ability to use persistence and ask probing questions to obtain thorough and accurate information.
Ability to work independently and within a team setting.
Must display a positive attitude.
Adapt to departmental and company procedures as necessary.
Update sales staff and verification team with pertinent information.
Participate and perform other duties as assigned by leadership
Competency
Demonstrate the BioPlus C.A.R.T. values.
Competence
Accountability
Respect
Trust
Excellent Computer Skills.
Knowledge of medical terminology.
Excellent communication skills.
Ability to work cooperatively and be a liaison between departments when needed.
Professional Image
Qualifications
High School Diploma or Equivalent
At least 1 year of insurance verification experience
Specialty pharmacy experience preferred
CPR experience a plus
CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants encouraged to apply. Drug-free work environment. Must be eligible to work in this country.
