Conduent Reimbursement Specialist in Basking Ridge, New Jersey
Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.
We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.
Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com at https://conduent.taleo.net/enterprise/akirax/flex/www.conduent.com .
If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
The Conduent, Patient Access Solutions group is nationally recognized for its planning, content, and process expertise in the design and management of compliant, streamlined reimbursement and patient assistance programs. The Conduent, Patient Access Solutions group is dedicated to delivering the highest-quality, leading-edge services so patients can experience the best possible medical outcomes.
The Reimbursement Specialist/Patient Support Specialist strives to eliminate barriers to reimbursement and access in patients with complex and rare medical conditions. The Reimbursement Specialist, reporting to the Program Manager or Program Supervisor, navigates patient’s healthcare insurance, performs administrative functions and interacts with key stakeholders in a call-center environment.
Reimbursement specialists require personal integrity, strong empathy, a high level of accuracy and superb attention to detail.
Key Job Responsibilities:
( Duties may include, but not limited to all or some of the following)
Accurately interprets patient insurance, prescription and other health-related documentation
Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payors
Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
Researches available alternative funding options to reduce patient’s financial burden
Handles high call volumes in a call-center environment
Communicates with internal and external departments to facilitate coordination of care
Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required and as per policy
Strictly adheres to Standard Operating Procedures (SOPs)
Analyzes records to transcribe appropriate ICD-9, ICD-10, CPT, HCPCS codes
Validates and enters prescription orders
Completes casework in a timely manner with consistent follow-up as the accountable case manager
Maintains patient confidentiality
Advocates on behalf of the patient to problem-solve reimbursement and access issues
Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc.
Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc.
Validate licensed practitioners
Required: Associates degree or equivalent work experience is required
2 - 3 years in pharmacy, managed care, Medicaid and/or Medicare organizations, pharmaceutical and/or biotech manufacturer, medical office, or related similar field
Preferred: 1 years within Specialty Medical Practice – ie. GI, infusion,
oncology, eye care
Buy and bill background
Prior experience with scheduling patients
Knowledge of Medical Terminology
Working knowledge or experience with resolving drug
Knowledge of HCPCS, CPT and ICD-9/10 billing and/or coding
Certification as Pharmacy Technician is plus
Knowledge of US private and government payors
Working knowledge of Microsoft Office (Word, Excel, Outlook)
Required: Customer focused
Fast and accurate data entry
Clear, pleasant speaking voice
Excellent communication skills (oral and written)
Ability to handle multiple tasks and troubleshoot issues
Ability to work with little or no supervision
Ability to adapt quickly to changing environment
Team player/consensus builder
Ability to interact with a diverse group
Project management skills
Ability to calculate figures such as discounts and percentages
Able to work a rotational shift between the hours of 8:00am and
8:00pm EST – Mon to Fri
All other duties as assigned.
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form at https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf .
Job Service Delivery Healthcare
Primary Location United States-New Jersey-Basking Ridge
Unposting Date Ongoing
Req ID: 18011505