Representative

• Perform specialized patient access and eligibility functions
• Liaise with payers, pharmaceutical companies, physicians, patients, and external clients
• Facilitate cross-functional resolution of drug coverage issues
• Research and resolve issues impacting revenue optimization
• Perform complex medical and pharmacy benefit verification using internal patient management tracking tools
• Contact benefit providers to gather policy benefits and limitations
• Coordinate services to ensure reimbursement, including deductibles, copayments, effective dates, levels of care, and authorizations
• Ensure shipments clear according to insurance criteria while minimizing bad-debt risk
• Provide expert assistance to clients on patient status
• Provide referral status reporting to external clients
• Handle challenging customers and complex client complaints, escalating as appropriate
• Complete other projects and duties as assigned
• Handle incoming and outgoing calls comprising approximately 30% to 50% of the workday

Representative jobs in Hawaii

Senior Eligibility Representative