Benefit Assessment Specialist
Company: Fresenius Medical Care
Posted on: June 25, 2022
This is a remote/work from home opportunity!
PURPOSE AND SCOPE:
The FreseniusRx Case Management team demonstrates a high level of
case management expertise to address patient concerns and
proactively plan for the maintenance of coverage. The case manager
is expected to facilitate the case management process along the
PRINCIPAL DUTIES AND RESPONSIBILITIES:
* Develops professional expertise; applies company policies and
procedures to resolve a variety of issues.
* Assesses patient prescription benefits and needs and develops
action plans that provides for the introduction and continuation of
* Maintains comprehensive understanding of the pharmacy benefit
process including but not limited to financial assistance programs,
insurance plans, and payer trends at a national, state, regional,
and local level.
* Assists in obtaining insurance approval and proactively plans for
maintenance of coverage.
* Works with patients, healthcare providers, insurance companies,
and internal operations staff to drive outcomes.
* Works on problems of moderate scope where analysis of situation
or data requires a review of a variety of factors. Can identify
complex issues and develop a plan accordingly related to benefit
* Builds and maintains productive working relationships with
internal and external customers
* May provide assistance to junior level staff with general tasks
that require a better understanding of functions, as directed by
* May refer to senior level staff for assistance with higher level
problems that may arise.
* Escalates issues to supervisor/manager for resolution, as deemed
* Reviews and complies with the Code of Business Conduct and all
applicable company policies and procedures, local, state and
federal laws and regulations.
* Assists with various projects as assigned by direct
* 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.
* This position requires up to 25% travel
* Bachelor's Degree required
EXPERIENCE AND REQUIRED SKILLS:
* 5 years' related experience; or an advanced degree without
experience; or equivalent directly related work experience.
* Healthcare, Social Work, or Nursing or a related field is a
* Experience in patient assistance programs, social service
support, case management review preferred
* Knowledge of benefit verification and prior authorization
* Knowledge of private payer, Medicare and Medicaid structure and
* Proficiency in CRM system
* Strong verbal and written communication skills
* Critical thinking and problem solving
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual
Fresenius Medical Care North America maintains a drug-free
workplace in accordance with applicable federal and state laws.
Keywords: Fresenius Medical Care, Franklin , Benefit Assessment Specialist, Other , Franklin, Tennessee
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