Remote Patient Services Representative

Starting at $17/hour, paid weekly 

8 am - 5 pm, Monday - Friday 

Remote (high speed internet required)

Equipment is provided

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

Triages cases with missing information to appropriate program associate

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

Identifies any restrictions and details on how to expedite patient access

Could include documenting and initiating prior authorization process, claims appeals, etc

Completes quality review of work as part of finalizing product

Reports any reimbursement trends/delays to management

Performs related duties and special projects as assigned

High school diploma or GED required

Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate’s degree program, technical vocational training, or equivalent combination of experience and education

Three years (3)+ years directly related and progressively responsible experience required

A two-year degree can be used in lieu of 2 years of the experience requirement or a four-year degree in lieu of the experience requirement

Depending on the program specific contracted services an associate may perform one or more of

the following activities: Inbound Phone Queue/General Program Inquires, determination for support programs (Copay, PAP, Medicaid, etc.), pharmacy triage and coordination, order processing for wholesale orders, other follow-up activities (missing info, prior authorization, etc.)

Intakes and reports adverse events as directed

Researches and resolves any claim denials or underpayment of claims

Effectively utilizes various means for collecting information using approved methods, which could include phone, fax, mail, and online methods.

Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly

Reports any trends or delays to program management (e.g. billing denials, claim denials, pricing

errors, payments, etc.)

Ensures all program correspondence and communication (phone, fax, mail, etc) meets quality standards

Works with patient, provider and or internal shared services to ensure all necessary documentation is received and complete in accordance with program policy

Works on problems of moderate scope where analysis of data requires a review of a variety of factors

Exercises judgment within defined standard operating procedures to determine appropriate action

Required to be self-motivated, working from a queue (phone or system

Expected to perform work in accordance with defined standard operating procedures

Management will monitor queues and provide active feedback as required

Performs related duties as assigned