Benefit Eligibility Specialist Jobs in Arkansas

Handle incoming calls regarding members' prescription benefits, including copay inquiries, medication coverage, and authorization processes

Educate members on how to effectively utilize their benefits

Troubleshoot pharmacy claims in real-time, verifying information, comparing claim results to benefit rules, and entering overrides when necessary

3+ years of prior medical customer service experience

Excellent phone etiquette and typing skills (40wpm, 500kph)

Basic knowledge of Microsoft Office and internet usage

Upload scanned images into the document management system.

1+ year of Call Center Experience

Provide 2-3 professional references if requested (managers/supervisors/leadership)

Receive and screen applications, and follow-up with customers to gather any missing information.

Verify income, calculate income, determine eligibility, and process case referrals.

Index and scan returned forms.

1+ year experience in complex health insurance verification, medical billing, or patient eligibility determination

1+ year experience working in a high volume call role

Experience using salesforce.com or similar CRM tools, preferred but not required

Calling existing patients to help them change their provider to One Medical with their insurance plan.

Communicating with insurance company call center representatives to resolve issues with patient eligibility

Following communication "scripts" when handling different topics

Must have knowledge of employee benefits, COBRA, and other federal/regulatory requirements

Processes benefit-related changes such as life-status changes, address changes, etc.

Resolves benefit administration service issues with internal staff and outside vendors

Counsels employees regarding benefit programs including plan features, procedures, eligibility, and premium information

2 years of related experience and/or training

Proficient PC skills (Microsoft Office, Outlook, HRIS, etc.)

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

Reports any reimbursement trends/delays to management.

An equivalent combination of education and experience will be considered.

Proficient Windows-based experience including fundamentals of data entry/typing.

Reviews all patient insurance information needed to complete the benefit verification process.

Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.

Perform data entry into the claims processing system, document management systems, databases, and spreadsheets as assigned.

Knowledge, Skills, and Abilities Required:

Ability to learn new skills and abilities.

Pharmacy Benefits Specialist I Responsibilities

Pharmacy Benefits Specialist I Qualification:

Educate members, providers, pharmacies, and staff about the formularies and pharmacy benefit policies.

Ability to multi-task using multiple computer systems with strong organizational and time management skills

Performs other responsibilities as assigned

One year of enrollment data or other related work experience

Beginner Excel experience required, Intermediate preferred

Demonstrated attention to detail and analytical skills relating to reconciling and problem-solving using data

Previous experience working with health insurance or in a health care environment preferred

2+ years' experience in client services, account management, or similar customer service related field

Manage assigned member caseload via high-touch advocacy model with a focus on elevating the member experience and promoting engagement.

Experience in healthcare and/or employee benefits

Understand product and program guidelines and working to educate CRMs and customers on the capabilities of and best practices for client.

Serve as the liaison to the support organization for client knowledge, and for appropriately managing escalations.

Imagine360 is currently seeking a Benefit Specialist to join the team!

Have good organizational, multi-tasking, and time management skills, with excellent attention to detail.

Have advanced Excel skills, with the demonstrated ability to write formulas, perform VLOOKUP, pivot tables, etc.

Have knowledge of EDI 270/271 transactions and insurance eligibility verification Have strong work ethic, resourcefulness, and the motivation to succeed

Have experience working with insurance companies in the healthcare provider industry

3-5 years previous experience in medical billing, current A/R & experience in patient services a plus.

Maintain knowledge of industry standards for insurance verification Understand and adhere to HIPAA policies, procedures, and regulations, maintaining strict confidentiality