The Eligibility Clerk is responsible for maintaining monthly eligibility verification and documentation for all active patients with nufactor. Eligibility clerk will also be responsible for verifying benefits for all active and pending patients with benefit changes and will assist with follow up on appeals/authorizations/denials/etc.
Essential Functions and Duties
Eligibility Clerk is responsible to verify monthly eligibility for all active patients with nufactor.
Eligibility Clerk documents all monthly verifications in nufactor system of record and reports any issues/changes/gaps in coverage to appropriate team members.
Eligibility Clerk will verify benefit changes for all active patients and report changes to the Authorization Coordinator
Eligibility Clerk assists Authorization Coordinator with annual benefit verifications to determine patient’s financial obligation, out of pocket expense and copays for the new benefit year.
Eligibility Clerk is responsible all follow calls on denials/appeals and documents all updates in system for record. Information must be relayed to appropriate team members.
Answers telephones utilizing appropriate etiquette when speaking with internal and external customers.
Complies with all nufactor policies and procedures and compliance requirements when engaging in activities related to the company.
Performs other duties as assigned.
Education, Knowledge, Skills and Experience
High School diploma or equivalent required.
One (1) year health care related experience in a pharmacy, home healthcare, infusion related setting or hospital preferred.
Must have strong organizational skills
Must have a detail orientation and the proven ability to prioritize work
Must have effective verbal and written communication skills
Must have the ability to work with limited supervision and as part of a team
Sound decision-making abilities
Knowledge of medical and pharmacy terminology preferred, basic office equipment use, good understanding of medical/pharmacy payers, insurances, copays coinsurance, insurance coverage knowledge ie: benefits/categories, deductibles, and out of pocket costs.
Excellent verbal and written communication skills and the ability to interact effectively with patients, co-workers and management.
Ability to work with a high degree of accuracy in an organized, detail-oriented manner with appropriate follow-up when required.
Ability to communicate effectively and at the appropriate level with healthcare professionals and peers.
Ability to prioritize work and make decisions independently and effectively, often quickly in response to dynamic patient needs, with limited supervision and direction, except where required/restricted by law.
Working knowledge of state, federal, URAC and Joint Commission guidelines/regulations/laws.
Ability to exercise discretion and maintain confidentiality to the level of required HIPAA standards.
Ability to use and understand Microsoft Office skills and internet technologies.
Represent the Company in a professional manner and appearance at all times.
Understand and internalize the Company’s purpose; Display loyalty to the Company and its organizational values.
Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.
Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for long periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled. Must have the ability to lift and maneuver items of at least 20 lbs. Working condition include normal office setting.
Learning, thinking, concentration and the ability to work under pressure, particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations’ situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions
FFF Enterprises is an EEO/AAP employer; all business decisions (employment, promotions, compensation, etc.) are made without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status. FFF Enterprises promotes an equal employment opportunity workplace which includes reasonable accommodation consideration of otherwise qualified disabled.
The above statements are intended to describe the general nature and level of work being performed by the incumbent assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and/or skills required of all personnel so classified.
The undersigned employee acknowledges receipt of the Job Description for the employee’s position and understands the essential functions, responsibilities and qualifications of the position. Furthermore, the employee acknowledges that this Job Description does not include all of the essential functions of this position, and that these essential functions may change as deemed necessary by the manager.
About FFF Enterprises, Inc and Nufactor Specialty Pharmacy
FFF Enterprises is the nations must trusted specialty distributor of plasma products, vaccines, biosimilars, and other specialty biopharmaceuticals and pharmaceuticals. Our partners include the largest and most influential GPO’s, servicing over 80% of United States hospitals and supplying the nations leading non-acute care sites. Our unprecedented programs unite manufacturers, GPO’s and hospital partners, resulting in cost-containment and more access to common and uncommon products.
Nufactor is the specialty pharmacy subsidiary of FFF Enterprises. It is dedicated to the chronic illness community, providing specialty products, in home infusions, and individualize patient care on a daily basis. Some of the services include 24/7 on call pharmacists, 24/7 on call infusion experts, Nursing services, patient and physician educational programs, patient advocates, and administrative services.