As a Patient Care Specialist III, you will verify patients insurance to locate the best benefit for the patient for both retail and mail order. Furthermore, you will schedule patient’s deliveries and addresses all patient needs in one phone call with positive and caring attitude. Some other critical components of this role include verifies patients insurance and run eligibility checks for all patients, complete and initiate prior authorizations, and triage referral to correct pharmacy when out of network. Also you will resolve invalid/incorrect rejections and follow through with insurance company in obtaining the correct response and enroll patients in co-pay assistance and Free Drug Programs.
- You will ensure proper follow-ups are initiated so patient’s therapy is not disrupted
- Responsible for loading insurance plans; primary and secondary if necessary
- Negotiate LOAs or an AOB with the insurance plan in coordination with leadership
- You will keep open lines of communication with physician offices and sales
- Ensures the highest quality of care is provided and is in compliance with federal, state, and local regulatory requirements and established departmental policies and procedures
- You will serve as subject matter guides as needed
- Ensures individualized goals are met
- You will display professional behavior, which aligns with company’s overall code of conduct and ethics
Advanced Care Scripts (ACS), a CVS Health Company, manages and dispenses specialty medications and products nationwide. Our comprehensive patient care model provides compliance and adherence support and cost-effective solutions for all classes of specialty medications.Required Qualifications
- High School Degree or equivalent
- At least two years’ experience in customer service, customer care or related field
- One year or more of experience in healthcare benefit verification/prior authorizations
- Six or more months working in either Microsoft Excel, Outlook, or WordPreferred Qualifications
- Familiar with co-pay assistance programs
- Call Center experience
- CPR+ experience
- Specialty Pharmacy ExperienceEducation
- High School Degree or equivalentBusiness OverviewIt’s a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
and EEO IS THE LAW SUPPLEMENT
. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our AdviceCounsel@cvshealth.com
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