Appeal Resolution Specialist jobs in Asheville, NC

PURPOSE AND SCOPE : Assists pharmacists by working directly with physicians, physician offices, dialysis facilities, and other pharmacies to ensure that patients' medication profiles are accurately completed and that patients receive the necessary medication refills in a timely manner.

PRINCIPAL DUTIES AND RESPONSIBILITIES :

Under the guidance of Registered Pharmacist, takes the appropriate actions to ensure the accuracy of patient medication files for enrolled or prospective patients and the accurate fulfillment of prescriptions for enrolled patients.

Works primarily with patient medication prescriptions and with medication prescribers. 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 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 FreseniusRx.
• Collaborates with related parties 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 Pharmacy Management System. 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 related parties during high volume times by taking patient calls.
• Assists pharmacists in dispensing as necessary.
• May perform intake duties and responsibilities which include but are not limited to : Acts as a primary liaison between clinics and provider (doctor) staff.
• Works system queue Pharmacy Management System to ensure documents processed in a timely fashion. Ensures patient Protected Health Information (PHI) is entered and updated correctly.
• Transfers patient profiles between FreseniusRx pharmacy locations. Ensures accuracy with clinic locations, addresses, and contact information.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• 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. EDUCATION :

• High School Diploma required; Associate's Degree desirable
• Pharmacy Technician Certification required
• Registered or able to be registered as a pharmacy technician in the state of Tennessee EXPERIENCE AND REQUIRED SKILLS :
• 1 - 2 years' related experience.
• Excellent customer service, communication, organizational and interpersonal skills required.
• Understands the importance of, and demonstrates a customer service philosophy.
• Excellent written and verbal communication skills.
• Excellent organizational and analytical skills.
• Detail oriented with the ability to enter information accurately on paper and into a database system.
• Proficient with PCs.
• Develops a 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 Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

EO / AA Employer : Minorities / Females / Veterans / Disability / Sexual Orientation / Gender Identity Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.

Last updated : 2024-04-24