PURPOSE AND SCOPE:
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
Leads a team of specialists in the Fresenius Rx business responsible for performing general customer service activities and acting as the primary contact for the pharmacy group. Activities include but are not limited to receiving inbound calls and making routine outbound calls. Acts as a resource and subject matter expert to patients, dialysis facility personnel, and other Fresenius Medical Care/Fresenius Rx staff.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Oversees the day to day work of assigned specialists in the Fresenius Rx business to ensure the appropriate execution of tasks related to but not limited to new patient enrollment, setting up new/existing prescription orders, resolving prescription issues/anomalies, maintaining pharmacy accounts, addressing insurance issues, adjudication of claims, patient financial accounts, and dispensing.
- Ensures that patient pharmacy needs are fulfilled in a timely, accurate, and service oriented manner.
- Acts as the primary liaison between the Fresenius Rx customer/patient and all Fresenius Rx departments, collaborating with personnel to ensure that all patient’s questions and prescription needs are met.
- Assists with the coordination of daily responsibilities of the team in terms of workload. Tracks the productivity of the team to ensure daily goals are achieved and that workloads are appropriately balanced.
- Mentors new staff members to facilitate attainment of required job skills and knowledge and intervenes where necessary to ensure appropriate treatment of situation and task.
- Assists with the identification of training and education needs of team members and provides basic training, as needed.
- Addresses and resolves complex issues across the business. Intervenes in challenging situations and works to resolve any escalated issues, when necessary.
- Consults with and updates supervisor, as needed regarding any team issues, task difficulties, and complex problems to ensure appropriate time resolution.
- Provides management with continual evaluation of effectiveness of processes and procedures, recommending methods to improve operations, efficiency, and service to customers/patients.
- Demonstrates a sense of urgency to call queues and customer requests/concerns.
- Maintains call ownership and provides continuous communication with customers until resolutions are reached.
- Strives to achieve single call resolution measurements.
- Employs troubleshooting techniques to define problems, collect data, establish facts, evaluate and resolve issues, or escalate to appropriate department/individual.
- Reviews complaints, issues, and requests to ensure all appropriate information has been obtained. Contacts customer or caller to obtain further information, when necessary.
- Coordinates with pertinent FMS staff and management to effectively respond to issues and inquiries. Ensures that the issue or need is addressed and resolved appropriately to satisfy the patient’s request. Provides assistance to colleagues by responding to inquiries regarding customer accounts.
- Manages workflow to ensure timely resolution and keeps management informed of escalated issues and their status.
- Prioritizes time to complete assigned tasks while maintaining a focus on productivity and customer satisfaction.
- Maintains records of all customer/patient interactions and transactions in the pharmacy system. Utilizes available tools to accurately document conversations or correspondences throughout each customer interaction.
- Adheres to and maintains all compliance and regulatory requirements associated with company policies, accreditation standards, Boards of Pharmacy, and state and federal governmental regulations and laws.
- Participates on special team projects for customer support and company initiatives.
- Works to develop solutions to customer problems and concerns to build customer loyalty and retention.
- Assist with various projects as assigned by direct supervisor.
- Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
- The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians.
High School Diploma required; Associate’s Degree desirable; and Bachelor’s Degree strongly preferred
EXPERIENCE AND REQUIRED SKILLS:
- Minimum of 4 – 6 years’ of experience in a customer service role required.
- Experience in a healthcare related field may be considered on a case by case basis.
- Previous call center experience strongly preferred.
- Previous pharmacy related experience strongly preferred.
- Billing & Collections experience in healthcare related field a plus.
- Bilingual (Spanish and English) preferred but not required.
- Excellent customer service, communication, organizational, analytical and interpersonal skills required.
- Understands the importance of, and demonstrates a customer service philosophy.
- Excellent written and verbal communication skills.
- Detail oriented with the ability to enter information accurately on paper and into a database system.
- Ability to learn and apply the basic skills needed to work with pharmacy system.
- Ability to interpret an extensive variety of technical instructions and convey those instructions to others.
- Ability to work independently, under general supervision.
- Ability to effectively prioritize work load to effectively meet established deadlines.
- Computer Skills, working knowledge of Microsoft applications.
- Develops working knowledge of pharmacy dispensing regulations, data systems, and billing practices and policies.
- Develops a working knowledge of standard medical abbreviations and medical terminology.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
- Responsible for functions as defined for the Customer Service Specialist position and assists in fulfilling those primary duties and responsibilities as needed.
- Fields daily inbound calls and makes routine outbound calls, assisting patients, physicians, and clinical staff with understanding the enrollment program, benefits of the program, as well as addressing any questions or concerns. Consults Pharmacist or supervisor regarding any escalated issues or complex questions, when necessary.
- Works with patients to acquire necessary details regarding medication needs as well as incumbent pharmacy and physician contact information.
- Obtains patient insurance information and notifies them of co-pay responsibility. Escalates questions related to insurance or financial obligations to the appropriate Insurance Specialist or AR Patient Account Representative.
- Works with clinical staff to facilitate the completion of patient enrollment. Receives daily inbound calls and makes routine outbound calls to and from clinical staff to address patient questions and concerns.
- Provides ongoing support and leadership in resolving various enrollment issues/problems, escalating to supervisor as necessary.
- Conducts customer service surveys to improve operational processes.
- Makes outbound calls and utilizes other communication methods to obtain the necessary information from patients and facilities to complete surveys.
- Maintains complete, organized documentation of all survey responses.
- Participates in retention activities as needed to help maintain the pharmacy group’s active patient base.
- Reviews pertinent retention reports, contacting patients as necessary.
- Follows up with inactive patients in the pharmacy system to help determine why they are not actively using pharmacy services.
- Responsible for functions as defined for the Patient Service Coordinator position and assists in fulfilling those primary duties and responsibilities as needed.
- Initiates communication with customers/patients by phone to set up new or existing prescription orders.
- Fields incoming calls from customer/patients on a daily basis.
- Contacts the pertinent customers/patients on a monthly basis to confirm current prescriptions, changes in prescriptions, or any additional prescriptions.
- Reviews patient’s medication needs and advises of early/late refills due in Rx Key (per prescriptions from physicians).
- Informs customer of any changes or delays in their order due to product shortages, product changes, recalls, or backordered and discontinued products.
- Determines the best delivery method based on the customer’s remaining days’ supply, delivery location, cost, and product stability.
- Resolves all order discrepancies interfacing with the appropriate Fresenius Rx departments to ensure resolution.
- Updates Rx Key patient/customer records with all appropriate and necessary documentation. Responsible for Medication Profiles and entering and completing enrollment forms.
- Reviews medication shipment activity and recommends inactivation when indicated.
- Ensures prescription validity with the patient.
- Prints medication summary profile in the Rx Key database for customers, upon request.
- Serves as the liaison between patients and Fresenius Rx regarding all service related issues.
- Researches, investigates, and resolves order delivery issues. Verifies correct information and obtains input from appropriate team or individual for prompt resolution.
- Initiates discussion with patients, as necessary, regarding accounts receivable balances if status jeopardizes service delivery.
- Directs appropriate questions to specific team or individual. Escalates complex issues to supervisor as necessary.
- Educates patients regarding Fresenius Rx services and procedures to appropriately set expectations and ensure a positive patient experience.
- Adheres to and maintains all compliance and regulatory requirements.
- Assists pharmacists in dispensing (if certified pharmacy technician), as necessary, and in accordance the Tennessee Board of Pharmacy Regulations.
- Makes suggestions to enhance processes.
- Responsible for functions as defined for the Prescription Specialist position and assists in fulfilling those primary duties and responsibilities as needed.
- After receipt of patient authorization, contacts physicians, physician offices, dialysis facilities, and other pharmacies regarding the accuracy and fulfillment of prescriptions for enrolled or prospective patients.
- Ensures that patient medication profiles are accurate and sent in a timely manner.
- Ensures that patient prescription needs are met in a timely manner.
- Speaks with physicians or nurses to verify correct information about a specific prescription.
- Regularly requests prescriptions and refills from physicians by telephone and/or facsimile. Follows up as necessary to ensure the timely receipt of new prescriptions.
- Contacts pharmacies to execute patient medication transfers to Fresenius Rx.
- Collaborates with Patient Service Coordinator for all communication with patients regarding prescription issues or other identified anomalies pertaining to prescriptions. Ensures issues are resolved according to procedures escalating the more complex issues to supervisor as necessary.
- Enters, scans, and links prescription and patient data into RxKey. Contacts appropriate parties or researches National Provider Identifier/Drug Enforcement Agency databases (NPI/DEA) when information is missing.
- Works to resolve Prior Authorizations and if necessary, contacts the insurance company for verification when Prior Authorizations are required.
- Ensures the required level of customer service for patients by:
- Prioritizing and completing assigned tasks appropriately and in a timely manner.
- Provides backup as necessary for Patient Service Coordinator during peak high volume times by taking patient calls.
- Transcribes verbal prescriptions phoned in by physicians and/or left on voicemail. Takes appropriate actions necessary to ensure accurate fulfillment of prescription(s).
- Assists pharmacists in dispensing, as necessary, and in accordance the Tennessee Board of Pharmacy Regulations
- Responsible for functions as defined for the Insurance Specialist position and assists in fulfilling those primary duties and responsibilities as needed.
- Verifies insurance coverage by phone, online, or through E1 (electronic system) transactions for new patients and/or changes in coverage.
- Contacts new patients (via telephone) to verify the amount(s) that will be paid out-of-pocket/co-pays.
- Maintains confidentiality of information at all times.
- Assists patients with understanding their pharmacy benefits and available resources.
- Educates patients regarding availability of alternative insurance options, such as providing Medicare part D assistance and education.
- Assists when insurance coverage changes between companies or to Medicare, and/or refers patients to a social worker.
- Answers patients’ questions regarding insurance coverage.
- Enters patient insurance information under the patient’s account in the pharmacy data system.
- Reviews enrollment forms. Ensures insurance information and appropriate referrals have been completely and accurately obtained. May be required to follow up with social worker, insurance company, and/or patient to complete the application and verify insurance.
- Demonstrates knowledge and understanding of insurance billing requirements.
- Monitors patients’ insurance information to ensure that it is updated and accurate. Addresses any identified anomalies or discrepancies, researches and answers questions as needed.
- Analyzes patient reports from pharmacy data system as an audit check to ensure the correct insurance information is entered and that other changes are not overlooked. Researches and corrects any discrepancies identified.
- Prepares monthly reports to track work progress.
- If Registered/Certified Pharmacy Technician, may assist pharmacists in dispensing as necessary.
- Completes work within authorized time to assure compliance with departmental standards.
- Responsible for functions as defined for the A/R Patient Account Specialist position and assists in fulfilling those primary duties and responsibilities as needed.
- Takes necessary actions to ensure resolution of AR issues and problems. Interacts with customers and FMS personnel as needed to accomplish resolution. Executes defined A/R processes accordingly, ensuring alignment with business controls and standard operating procedures.
- Assists customers with incoming phone and email inquiries to quickly and accurately resolve questions/disputes with regard to invoicing. Escalates to supervisor if necessary.
- Contacts customers/payers to secure payment on past due accounts. Performs daily review of customer payments, ensuring accuracy at all times.
- Proposes payment agreements on accounts with Slow Pay status.
- Follows up on previously submitted but unpaid claims to clear up unpaid accounts.
- Administers credit holds and suspension of services due to non-payments.
- Assists in the tracking and monitoring of aging and collections accounts.
- Releases orders on credit hold in accordance to policy and procedure. Monitors, processes, and updates credit card profiles.
- Provides information and assistance to Patients/Insurance Companies. Performs administrative functions relative to Patient/Insurance issues.
- Processes Medicare denials for re-transmission or for review.
- Prints and mails invoices in accordance to schedule provided by the management team. Processes changes to customer profiles in various billing and provisioning systems to ensure delivery of invoices and billing deliverables.
- Assists in the review of all requested price changes/billing cycles for accuracy and timeliness, as requested.
- Maintains A/R spreadsheets and accounts receivable reports required for Management Reporting.
- Reviews with manager the delinquent accounts considered to be uncollectible to ensure maximum efforts have been taken before assigning to an outside agency. Prepares and submits weekly delinquent customer reports.
- Submits credit and collections documentation to support audit and legal requirements.
- Requests credit/debit memos and initiates refund requests pursuant to submitted requests and customer disputes.
- Responsible for functions as defined for the Adjudication Specialist position and assists in fulfilling those primary duties and responsibilities as needed.
- Reviews and processes claims in the RxKey software application Adjudication Work Queue.
- Reviews and verifies patient accounts for full insurance coverage. Contacts the patient’s insurance company and/or patient when a claim is rejected during the billing process.
- Verifies order information with customer service coordinators and ensures that all necessary items appear in line with routine processes. Cancels orders if necessary and reestablishes the order with correct date or information.
- Reviews all orders set up to bill directly to the patient to ensure correctness.
- Responsible for timely and accurate billing. Prepares and sends patient statements, upon request.
- Resolves or assists in resolution of rejected or failed claims. Escalates complex issues to supervisor as necessary.
- Initiates review of claims paid under cost.
- Makes collection calls and obtains payments for customer accounts receivable accounts.
- Recommends customer accounts receivable accounts for bad debt write-off or for collection referral.
- Obtains information relative to prior authorization requirements from third party payers. Responds promptly to all third party and patient inquiries including telephone calls and written correspondence.
- Communicates prior authorization requirements and all necessary information to complete prior authorization requests to the pharmacy technician who handles prior authorizations.
- Assists pharmacists in dispensing as necessary.
- Maintains patient confidentiality at all times.
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
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