PURPOSE
The Eligibility Specialist is a member of the Intake team and is responsible for checking eligibility and benefits as well as submission/follow-up of authorizations.
DUTIES
The duties of this position are those described below. This job description does not state or imply that the duties listed are the only duties and responsibilities assigned to this position. Employees holding this position will be required to perform any other job-related duties as requested by management. Acts with urgency to meet the needs of the business and gives input on solutions to respond to gaps in the operations, and/or improvements to performance and service levels
Screen patients for eligibility check
Assist in Intake processes
Follow up with provider offices for missing documents
Follow up with patients regarding status and information requested
Work with processing teams on effective eligibility and authorization turnaround times
Complete a comprehensive benefit and qualifies health insurance assessment for each patient
Verify and update patient demographic information in pharmacy system.
Obtains customer/patient information for onboarding patients
Answer patient/caregiver questions about general matters, such as, pharmacy operating hours and contact information.
Submit refill order tickets on behalf of patients, caregivers, and health care partners
Provide patient/caregiver basic information related to eligibility and coverage, and benefit-related issue resolution.
Provide patient/caregiver medication information related to prescriber information, number of refills left or number of refills allowed, and/or any insurance authorizations on file.
Provide patient/caregiver refill order status
Research and provide delivery updates to patient, caregivers, and health care partners
Submit urgent order/status messages on behalf of patient/caregiver, to the pertaining department to meet order completeness to the expectation of patient/caregiver.
Assist departments with patient communication
Return messages left in call center voicemails box within 24hours
Other duties as assigned
EDUCATION REQUIREMENTS
High school diploma or equivalent, college level a plus
EXPERIENCE REQUIRMENTS
Must have a high school diploma
A minimum of 2 years of experience with eligibility/authorization
Proficiency in a Windows computer software (MS Word/Excel) preferred
Excellent oral and written skills
Exceptional interpersonal skills and team player
Ability to work independently and self-manage
Ability to execute “outreach plans” collect data, and prepare reports
Follow agency policies and maintain organizational standards with regards to client confidentiality and HIPAA compliance
Bi-Lingual English/Spanish preferred
EQUIPMENT USED
PC, Calculator, Office Copying, FAX and Scanning Machine
COMPUTER SKILLS AND APPLICATIONS
Good proficiency in Microsoft Office Suite (Word, Excel) familiarity with PowerPoint, Outlook; ability to use the Internet for research and information in support of job duties.
PHYSICAL DEMANDS (All requirements are subject to possible modification to reasonably accommodate individuals with a disability)
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee may be required to sit, stand, stoop, bend and walk intermittently during the day.
May be necessary to work extended hours as needed.
The employee is occasionally required to climb, balance, stoop, kneel, crouch, crawl; talk or hear; taste or smell; use hands to finger, handle, or feel; and reach with hands and arms. Finger dexterity to operate office equipment is required.
May need to lift up to fifty (50) pounds on occasion.
Visual acuity to see and read fine prints.
Specific vision abilities required by this role include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Mini Pharmacy is an equal opportunity employer, dedicated to promoting a culturally diverse workforce.
All qualified applicants will receive consideration for employment without regards to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
City of Los Angeles’ Fair Chance Initiative:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance.