Descripción y detalle de las actividades
Patient Care Service (PCS) Representatives seek benefit coverage for patients from insurance groups with the responsibility of timely and compliant order entry, benefit verification and prompt follow up. This position works collaboratively with cross-functional internal and external teams to obtain necessary documentation required to obtain insurance authorizations. Essential Duties and Responsibilities: - Answers inbound and outbound calls, research, and identifies insurance to ensure compliant/proper account resolution. - Verifies insurance eligibility and follows coordination of benefits guidelines. - Faxes accurate and thorough Pre-Authorization Request Letters. - Determines revenue amounts based on allowable, benefits, unit price, payer guidelines, copayment and contract pricing. - Submits appropriate and accurate billing to Government entities and private insurance payers consistent with Federal, State and insurance specific requirements. - Pursues supporting documentation from Sales Team to ensure all required documents are received prior to invoicing. - Reviews prescriptions, Letters of Medical Necessity and/or Chart Notes to ensure both completeness and accuracy. - Ensures that orders meet criteria and compliance standards, and resolves assigned denials and variances by accurately determining the root cause and collaborating to reduce the denial or variance. - Works to resolve submission issues which can include obtaining the appropriate Medical Record documentation or validation of coding. - Reviews orders for accuracy and completeness prior to providing the "OK to Place" and invoicing. - Processes assigned correspondence and telephone inquiries from patients and payers in a compliant manner and promptly responds in writing or verbally. - Appropriately challenges insurance companies by communicating information on Medical Necessity and negotiating coverage and pricing for the purchase of our products that meet all applicable payor guidelines. - Serves as back-up for other PCS Representatives and their assigned region(s), as needed.
Experiência y requisitos
**Número de vacantes** 1
**Área** Atención a Clientes/Call Center/Telemarketing
**Contrato** Permanente
**Modalidad** Presencial
**Turno** Diurno
**Jornada** Tiempo Completo
**Estudios** Preparatoria
**Sexo** Indistinto
**Disponibilidad p. viajar** No