Benefits Verif Tech

Position Summary: 

TheBenefits VerificationTechnicianisresponsibleforprovidingassistanceto members, insurance carriers, and providers with inquiries for member’s eligibility for claimsprocessing.  Assists with questions and correspondence to find resolution to all problems with a patient’s prescription.  

Essential Duties/Responsibilities: 

• Placeoutboundphonecallsregardingpharmacyprescriptionstoproviders,insurancecarriersandpatientstoobtainprescriptionand/orbillingclarification;follow-upasneededforresolution. 

Contactmemberstoobtaininformationortoadviseofadelayinorderprocessing. 

Coordinateadjudicationsupportwithpharmacybenefitmanagement(PBM)services. 

Processprescriptionsusingcurrentinsurancedataandrequirementsforadjudication. 

Properhandlingofroutineinquiriesfrommembers,providers,pharmacies,andpayers 

Maintainrecordofcorrespondence,recordingdetailsofinquiries,complaints,commentsaswellasactionstaken 

Coordinatewithpharmacisttoresolvememberprescriptionissuesasneeded. 

Organizeandmaintainreferencesheetsfortheteamaschangeswithinsurance payersoccur. 

Assistwithtrainingandupdateswithinthedepartmentoftechniciansasneeded. 

Assistcustomerserviceandotherdepartmentswithvarioustasks,includingmembercorrespondence,asneeded. 

Assistsupervisorwithupdatesorchangesinprocessesandprocedureswithinthedepartment,includingkeepingupwithchangesinadjudicationstandardsandrequirements. 

Assistinprescription/businessauditsforthirdpartypayers. 

Achieveindividualperformancegoalsforproductivityandquality. 

Advisesupervisor(s)ofescalatedissues. 

Performs other duties as assigned. 

Required Skills/Abilities:  

• Excellent verbal and written communication skills.  

Excellent interpersonal and customer service skills. 

Excellent organizational skillsand attention to detail. 

Excellent time management skills with a proven ability to meet deadlines, prioritize work and work independently. 

Abilitytoexerciseconsiderablejudgment,maintainconfidentiality,andactinadiplomaticmanner. 

Abilitytocollaboratewithpeersinateameffort. 

Strong analytical and critical thinking skills. 

Ability to function well in a high-paced and at times stressful environment. 

Proficient in Microsoft Office and industry related software programs 

Ability to work extended hours, weekends, and holidays in alignment with departmental and industry demands  

Education/Experience: 

• High School Diploma , Undergraduate degree desired or equivalent work experience. 

Current Pharmacy Technician with National Certification OR Registered Pharmacy Technician Status with applicable State Board of Pharmacy 

At least 2+ years in Pharmacy setting. Prior experience in Retail, Mail Order of Specialty Pharmacy, PBM, pharmaceutical or managed health care industry preferred. 

Knowledge of claims adjudication preferred. 

Knowledge of secondary billing practices including prescription discount cards and Medicaid preferred. 

Work Environment/Physical Requirements:  

Prolonged periods ofsitting, standing, walking, and working on a computer. 

Ability to bend, reach, stoop, kneel. 

Ability to utilize visual acuity to operate equipment and read technical information. 

Ability to lift 15 pounds at times.