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Job Details


Fresenius

Pharmacy Benefits Specialist

Healthcare

All

Full Time

On Site

No

Franklin, Tennessee, United States

PURPOSE AND SCOPE: Position effectively and efficiently reviews and verifies patient’s insurance coverage for medications. They may also be required to process orders in the pharmacy management system’s work queue. Finds and acts upon trends in pharmacy data that will help the pharmacy improve customer enrollment and retention.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Verifies insurance coverage by phone, online or through electronic transactions where appropriate for all new patients and/or changes in coverage.
  • Makes contact (via telephone and/or email) with patients and Fresenius Medical Care clinics as needed to address a patient’s medication coverage.
  • Answers patients’ questions regarding insurance coverage and financial assistance options.
  • Reviews enrollment forms and ensures insurance information and appropriate referrals have been completed and accurately obtained. May be required to follow up with FKC clinic staff, insurance company, and/or patient to complete the pharmacy enrollment and verify insurance.
  • Monitors all patients’ insurance information to ensure that it is updated and accurate. Addresses any identified anomalies or discrepancies, research and answers questions as needed.
  • Where applicable, transfers scripts from other pharmacy if patient requests transfer of prescription to FreseniusRx.
  • Demonstrates knowledge and understanding of insurance billing requirements. Understands Medicare part D plans, commercial pharmacy coverage, Medicaid plans, and also any assistance funds or plans that are available for ESRD patients.
  • Acts as a subject matter expert for patient prescription benefits and needs and develops action plans that provide for the introduction and continuation of therapy.
  • Assists in obtaining insurance approval and proactively plans for maintenance of coverage.
  • Under limited supervision, applies considerable (insert) knowledge to perform a broad range of tasks which include but are not limited to…
  • Works on assignments that are moderately difficult, requiring judgment in resolving issues and/or in making recommendations.
  • Normally receives no instruction on routine daily work, and general instructions on newly introduced assignments.
  • May escalate issues to supervisor for resolution, as deemed necessary.
  • Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
  • Assists with various projects as assigned by direct supervisor.
  • Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUPERVISION:

  • None

EDUCATION:

  • High School Diploma required; Associate’s Degree desirable
  • Pharmacy Technician and Licensure Preferred

EXPERIENCE AND REQUIRED SKILLS:

  • 2 – 4 years’ related experience.
  • Excellent customer service, communication, organizational and interpersonal skills required.
  • Demonstrates a customer service philosophy.
  • Excellent written and verbal communication skills.
  • Excellent organizational, analytical, and problem-solving skills.
  • Detail oriented with the ability to enter information accurately into a database system.
  • Proficient with PCs and Microsoft Office Suite applications including Microsoft Excel and PowerPoint
  • Possess a working knowledge of pharmacy dispensing regulations, pharmacy data systems, and pharmacy billing practices and policies.
  • Possess a working knowledge of standard medical abbreviations and medical terminology.
  • Preferred knowledge of PBM systems and Salesforce

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.