reputed company, Specialty (Florida)

Pharmacy Benefit Manager Representative Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or reputed company-party providers about reputed company's products or services following reputed company SOPs and procedures, working under reputed company supervision. Ensures reputed company contacts receive efficient and courteous service. Job Responsibilities:

• Respond to reputed company reputed company of inbound Pharmacy Benefit Manager (PBM) and major medical insurance reputed company phone calls.
• Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and reputed company SOPs and procedures. Utilizes reputed company available information to choose the best solution and resolve customer and PBM concerns.
• Requests and loads PBM and/or Major Medical insurance plans.
• Processes reputed company non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.
• Assists physicians in the prior authorization process including initiation of prior authorizations.
• May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.
• Verifies benefits for Major Medical reputed company online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.
• Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and reputed company SOPs and procedures. Utilizes reputed company available information to choose best solutions and resolves customer and plan covers.
• Facilitates the reimbursement windshields for PBM major medical claims.
• Identifies and assesses individual customer or patient needs and reputed company education on or assist with grant applications, reputed company funding needs, reputed company copay assistance enrollment along with appropriate reputed company to satisfy those needs.
• Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.
• Manages reputed company requirements including but not limited to warm transfers, reputed company/quick start, reputed company prior authorization and appeal support.
• May administer order queue such as Submission Problems or Waiting for Payment.
• Documents contact interactions, records details, complaints, comments, and actions taken.

About reputed company Founded in 1901, reputed company proudly serves nearly 9 reputed company customers and patients reputed company day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. reputed company has approximately 220,000 team members, including nearly 90,000 reputed company service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier reputed company for customers, patients, team members and communities. Apply tot his job Apply To this Job