Eligibility Associate

At Express Scripts, a Fortune 100 company, we provide pharmacy benefits management services to tens of millions of consumers through thousands of employers, government and union health plans. We call St. Louis home, but there are administrative, pharmacy, and customer service operations throughout the United States and Canada. Express Scripts continues to expand its services with more than 14,000 employees focused on our mission to make the use of prescription drugs safer and more affordable Since 1986, the company';s legacy of independence ensures that our interests are aligned with plan sponsors and their members. We share a common cause with each of our clients to help offer a healthy prescription-drug benefit today and into the future. As an employee you can be proud knowing you';re improving the quality of life of millions of people every day.
ABOUT THE DEPARTMENT
CuraScript, a wholly owned subsidiary of Express Scripts, is a leading national provider of specialty pharmacy services. CuraScript offers a broad range of healthcare products and services for individuals with chronic health conditions, such as growth hormone deficiencies, hepatitis C, hemophilia, HIV/AIDS, oncology, multiple sclerosis, and rheumatoid arthritis. CuraScript provides comprehensive patient management services including clinical case management programs, counseling, education, outcomes measurement, social services, and reimbursement services. CuraScript Wholesale Services provides customized supply chain solutions for the biotech industry.
RESPONSIBILITIES
The primary goal of this position is to effectively transition patients information, received via fax and/or client partner download, into our client database program and prepare necessary files to expedite the process of getting patients started on client product. Review incoming referrals for completeness of and confirm FDA requirements are met. These are typically received via facsimile, Web portal or client partner download. Answer all Incoming calls on Hotline quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team. Accurately enter preliminary patient information into client database system and send fax confirmation to physician office or home care. Prepare patient file and attach all necessary documentation and correspondence and assign referral to the appropriate RA/CSR. Make up to 2 attempts at a connection call to patient/family to introduce our program and screen for eligibility for free drug program. Reopen cases in database as requested for Insurance changes and reauthorizations as they expire. Accurately enter orders for drug placed by phone and fax from homecare centers and pharmacies. Answer inquiries regarding status of orders placed. Generate and mail brochures, letters and patient authorization forms to patients for completion, as well as follow up letters for same. Send fax updates to physicians Other duties as needed. Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.
QUALIFICATIONS
High school graduate with a minimum of 1-2 yrs data entry and or customer service experience, preferably in the health insurance industry. Knowledge of medical terminology, prior authorizations and appeals required. Detail oriented with good analytical skills. Excellent written and verbal communication skills with the ability to interact well at all levels Must be well organized and have the ability to multi task. Computer proficiency in MS Office applications Pharmaceutical/Medical insurance reimbursement knowledge preferred.
EEO STATEMENT
Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class. None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics. Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.