Company Name:Kroger Specialty PharmacyPosition Type:EmployeeFLSA Status:N/A
Position SummaryPerform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice. Demonstrate the companys core values of respect, honesty, integrity, diversity, inclusion, and safety.Essential Job FunctionsCommunicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cardsInvestigate and verify benefits for pharmacy and medical third-party claims for assigned casesObtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informedReview for accuracy of prescribed treatment regimen prior to submission of authorizationFacilitate appeals process between the patient, physician and insurance company; compose clinical appeals letters based off of specific denial reason and patients clinical presentation and coordinate appointment of representative documentComplete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off of eligibility and specific drug prescribedTrack, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay serviceNotify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions)Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacyComplete a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when requiredDocument case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact recordsEnsure that work activities are conducted in compliance with regulatory requirements and the organizations defined standards and procedures, and in a manner that provides the best available level of service and qualityPerform or assist with any operations, as required to maintain workflow and to meet business needsPerform other related duties as assignedMust be able to perform the essential job functions of this position with or without reasonable accommodationMinimum Position Qualifications High School Diploma or GED1 year of proven work experience in a healthcare or customer service industrySuperior telephone customer service skillsStrong organization skills as well as attention to detailExcellent knowledge of insurance benefit investigation process and techniquesDemonstrated ability to manage a range of priorities and meet time commitmentsExcellent data management software skills with demonstrated adaptability to internal systemsDemonstrated strength in listening, oral and written communications in EnglishDesired Previous Experience/EducationPharmacy Technician CertificationAny additional training in pharmacy/medical benefit access and requirementsAny healthcare experience with a basic understanding of clinical terms and benefits investigationAny previous experience in a call center preferred where performance was measured
Education Level: High School Diploma/ GED RequiredRequired Certifications/Licenses: NonePosition Type: Full-TimeShift(s): [[mfield4]] Regions :Any
States : Louisiana
Jobs at Kroger: At Kroger, we hire people who have a passion for helping others and who want to build a relationship with our Customers. No matter what stage of your career, you can build your future at Kroger. We look for people who want more, aspire to be more and work hard to achieve their goals. Our focus on keeping the Customer first is what makes us successful. We offer many opportunities not only in our stores, but in Manufacturing, Logistics, Marketing, Finance, Human Resources, and many other fields.
Company Overview: Kroger Family of Companies employs nearly half a million associates who serve over 11 million customers daily through a seamless shopping experience under a variety of banner names . At The Kroger Co., we are Fresh for Everyone and dedicated to our Purpose: To Feed the Human Spirit. We are committed to creating #ZeroHungerZeroWaste communities by 2025. Careers with The Kroger Co. and our family of companies offer competitive wages, flexible schedules, benefits and room for advancement.