- Experience Level
- Experienced (non-manager)
Job Title: Eligibility Specialist
Provide the highest quality of customer service to patients and client representatives, which entail acquiring in depth knowledge of client and marketing requirements. Complete verification of Benefits and Eligibility for all referrals from patients, medical doctor’s office (MDOs), health plans and pharmaceutical manufacturers. Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting on therapy.
Specific job duties:
- Review incoming referrals for completeness of and confirm FDA requirements are met as applicable. These are typically received via facsimile, Web portal or client partner download.
- Answer all Incoming calls quickly and efficiently, evaluate their need and respond or disseminate call to appropriate member of team.
- Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, and other reimbursement issues from patients, MDOs, payers and Sales Representatives
- May provide billing and coding information related to specific product(s)
- Conduct general payer research
- Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy.
- Participate in call center activities, triage, and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.
- May serve as single point of contact for an assigned group of prescribers.
- Effectively manage and work though action item list to ensure it is current and tasks are completed in a timely fashion.
- Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns.
- Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.
- 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.
- Other duties as assigned.
Desired Skills and Qualifications:
- High School diploma or equivalent
- 3-5 years’ experience in a customer service setting preferably in a call center environment; Previous experience in the PBM and or Healthcare Industry preferred
- Computer proficiency in MS Office applications, with database experience preferred
- Health insurance claims or patient accounting experience preferred
- Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred
- Detail oriented with good analytical skills
- Ability to manage multiple priorities and meet deadlines
- Excellent written and verbal communication skills, demonstrated ability to communicate with others at all levels
- Excellent customer skills-patience to explain details and processes repeatedly, excellent phone presentation skills
- Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
- Advance problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
- Ability to work a flexible schedule
United BioSource Corporation (UBC) is a leading provider of pharmaceutical support services, partnering with life science companies to make medicine and medical products safer and more accessible. Our services support the full lifecycle of medicine and medical products, including development, commercialization, and long-term value and safety.
While UBC offers employment within Patient Support, Nursing, Pharmacy and Corporate, two main focus areas for the company are Clinical Development & Research and Safety & Risk Management. Members of the Clinical Development and Research teams help evaluate study protocol, target study population, recruit physicians and patients, and collect, clean, validate and report data. As a result, sponsors are able to submit findings to regulatory authorities or make a no-go decision in a timely and clear-cut manner. Additionally, our Safety and Risk Management teams develop, deliver, and report evidence to reinforce safe and appropriate product use.
Through our Patient Access services, we help patients begin therapy quickly and remain on therapy, building strong relationships with patients to ensure optimal care.
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