Benefits Advocate

Working at Express Scripts says something about your commitment to quality, your integrity, and desire to excel in your career. Since 1986, many outstanding people have contributed to our success as a Pharmacy Benefits Management leader and Fortune 500 company with over $15 billion in sales. Benefits Advocate Participate in Call Center activities, such as Hot Line coverage which entails triaging incoming calls from patients, medical offices and home cares/pharmacies, as well as order processing Obtain any missing information necessary in activating patient file Conduct benefit investigations and verify insurance benefits on behalf of patient Accurately enter data in all pertinent/required fields of client database Provide coordination for therapy initiation and/or pharmacy Provide product shipping coordination as necessary Analyze coverage level, assess patient for eligibility in uninsured patient programs and conduct alternative funding research as applicable Send all requests for 1040’s – includes first and second request/letters. Monitor patient enrollment outcome when alternative funding is utilized until funding is obtained Prepare, monitor and provide additional supports as necessary on prior authorizations and non-medical appeals until funding outcome resolution is obtained Effectively utilize the Tickler function of client database to monitor outstanding items on each client case file Conduct medical appeal survey with patient/family and work effectively with Nurse Case Manager Produce written notification to patients regarding the status of their case file Insure that all patient files are maintained and inclusive of all communications as well as medical and other documentation associated with working each case so that any other employee is able to clearly see what steps have been completed and determine the current status Provide necessary support to client’s sales representatives regarding patient status, reimbursement management, Medical Offices and Homecare management Interface with client’s representatives from other departments as necessary Interface with vendor partner as necessary Participate in conference calls with medical offices Survey physician profile information, enter necessary information into client data base and re-verify information bi-annually Provide assistance in Billing/Coding as necessary Provide minimal claims tracking – A/R activities Obtain re-certification for cases requiring extended treatment and coverage beyond the expiration of original approval.Qualifications:Knowledge: High school graduate with 1-3 years Health Insurance Claims or Patient Accounting experience. Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals. Familiarity with Medicaid reimbursement process.Skills and Abilities: Computer proficiency in MS Office applications Detail oriented with good analytical skills Excellent written and verbal communication skills with the ability to interact well at all levels Must be well organized and have the ability to multi task Bi-lingual a plus.To apply log on to www.express-scripts.com/careers and search for job ID#7320. EOE m/f/d/v