- Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
- Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
- Contacts benefit providers to gather policy benefits/limitations; coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.). Directly interfaces with external clients.
- Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.
- Provide expert assistance to clients on patient status. Liaison for company providing referral status reporting.
- May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome. Handle Escalations. Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.
- High school diploma or GED required; bachelor's degree preferred.
- 3+ years of relevant working experience; Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
- Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge.
- Extensive knowledge of ESI products and services a must.
- Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.
- Excellent phone presentation and communication skills.
- Demonstrated ability to handle challenging customers in a professional manner.
- Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
- Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
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Customer Service Senior Representative - Orlando, United States - The Cigna Group
Description
The job profile for this position is Customer Service Senior Representative, which is a Band 2 Professional Career Track Role.Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
POSITION SUMMARY
The Customer Service Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership's knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals and provide accurate status reporting to clients.
ESSENTIAL FUNCTIONS
QUALIFICATIONS
KNOWLEDGE AND ABILITIES
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
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