Reimbursement Specialist

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
The Client & Patient Services organization is responsible for ensuring high-quality service delivery to Express Scripts members and clients in a cost-efficient manner. Patient Services provides mail pharmacy services, addresses members inquiries and provides value-added consultation. In addition this organization includes Client Services, which encompasses client and benefit administration, quality control, implementation, client support center (CSC), participant materials, clinical operations and eligibility. In addition, Client & Patient Services includes centralized functions to drive continuous process improvement, pharmacy compliance and forward-looking planning. This organization also includes Medical Affairs, Clinical Services, and Express Scripts Pharma Business Services subsidiary.
RESPONSIBILITIES
Daily communication and counseling with patients and physician offices regarding fund referral eligibility and application. Receive and enter all new program enrollee information in software system. Reviewing, processing and maintenance of all application and accompanied paperwork submitted for eligibility. Preparing and mailing all patient and physician correspondence associated with fund referrals. Performing insurance verification, if applicable. Work with other operational departments to research and problem solve. Other special projects as needed. ESSENTIAL FUNCTIONS:
1.Daily communication and counseling with patients and physician offices regarding fund referral eligibility and application. 2.Handle inbound and outbound calls to/from patients / physician offices / social workers. 3.Effectively be able to counsel patient / physician office / social worker on enrollment application and fund referral eligibility. 4.Review, process, and maintain all paperwork submitted for patient eligibility. 5.Review patient information for eligibility to patient assistance program. 6.Review patient information for eligibility to alternate funding source. 7.Prepare correspondence for patients and physicians. 8.Process appeals per program guidelines. 9.Professionally communicate with other sources inside / outside of company. 10.Communicate with other departments regarding patient issues. 11.Contact insurance companies to verify patient benefits. 12.Contact funding sources to verify patient eligibility status and assist and/or expedite eligibility determination. 13.Other Projects Based on Business Needs
QUALIFICATIONS
-High School Graduate. -2+ years secondary education preferred or equivalent work experience. -Experience in health insurance industry or alternate funding. -Excellent phone presentation skills and communication skills. -Demonstrated ability to handle challenging customers in a professional manner. -Strong analytical skills required. -Computer experience with Microsoft Office, E-mail, and Internet. -Ability to work flexible schedule to accommodate business needs