Pharmacy Claims Representative - Patient Financial Services

Profile

Description

The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Use your business knowledge to help analyze data and provide financial support. Humana is seeking a Patient Finance Specialist that will work on the behalf of Humana customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy.

Responsibilities

The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Patient Finance Specialist detailed description:


Source Patient Assistance program and/or foundation to assist patients in meeting Out Of Pocket responsibility

Take inbound and make outbound calls related to Patient Assistant Program, billing inquiries, and insurance verification

Provide customer service (internal/external)

Documenting case files with complete notes on work

Complete special projects with varied and complex components as needed


Required Qualifications


High school diploma or GED

1 to 2 years of customer service experience

Previous experience working phones on an incoming and outgoing basis

Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook

Intermediate to High level of Windows Based system navigation

Must be able to work a shift between 8am and 8pm EST Monday-Friday


Role Desirables


Bachelor’s Degree in Finance, Accounting or a related field

Previous Healthcare and/or Mail Order Pharmacy experience

Fluency in Spanish


Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

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