Third Party Liaison with over 7 years of successful experience in implementing business requirement and identifying system enhancements. Recognized consistently for performance excellence and contributions to success in Pharmaceutical reimbursement industry. Strengths in advanced organization skill and attention to detail backed by training in Healthcare Information Systems.
The Third Party Liaison serves as a liaison between the operations program(s) and third party vendors of the manufacturer. Vendors could include but not limited to specialty pharmacies, data aggregators, and other service providers. The Third Party Liaison proactively monitors program reports to assess adherence to business requirements and ensures that services are coordinated in a way that manufacturer expectations are met.
Lead and facilitate calls with 3rd party contacts (and client, if applicable) to monitor patient progress, reconcile data discrepancies, research missing data, handle inquiries and provide updates as requested.
• Create and maintain action log, agendas and minutes for each meeting they lead.
• Handle inbound/outbound calls from all applicable customers including but not limited to 3rd party contacts, client contacts, third party vendors and internal team resources.
• Triage and/or approve work referrals to 3rd parties as needed.
• Reference and implement business requirements as it pertains to operating procedures, validation of incoming data from the 3rd party, and identifying and escalating data feed issues internally and externally.
• Identify needed system enhancements and/or reports and participate in requirement review, testing and implementation.
• Implement business requirements for newly-contracted 3rd party interfacing with the program(s) supported to ensure adherence to all contractual obligations; ensure all data is validated prior to program launch.
• Share best practices and learning opportunities with program implementations and peers.
Initiate patient treatment, schedule necessary prescreening tests, review co-pay grant eligibility, and complete the transfer to a specialty pharmacy for continued service.
Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
Effectively utilizes various means for collections including but not limited to 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.
Maintains frequent phone contact with provider representatives third party customer service representatives pharmacy staff and case managers.
Reports any reimbursement trends/delays to supervisor (e.g. billing denials claim denials pricing errors payments etc.).
Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
Collects and reviews all patient insurance benefit information to the degree authorized by the SOP of the program.
Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials.
Processes any necessary insurance/patient correspondence.
Provides all necessary documentation required to expedite payments. This includes demographic authorization/referrals National Provider Identification (NPI) number and referring physicians.
Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation. Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
Researches and resolves any claim denials or underpayment of claims.
Job Complexity: 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. Builds productive internal/external working relationships.
Supervision: Typically receives little instruction on day-to-day work general instructions on new assignments.
Manages inventory: orders stock prescription drug, pharmacy supplies, over-the-counter products, return nonmoving and expired drugs.
Files electronic claims to insurance companies and process audit request paper work from insurance companies. Arrange and make copies of pharmacy documents and forms. Keep and manage paper record of narcotic drugs.
Performs compounding techniques on medication orders from healthcare providers.
The Masters of Business Administration program offers a broad set of business management tools while also allowing students a choice of concentration in order to tailor their degrees to fit their careers and learning goals. The program curriculum prepares working professionals to become effective decision makers and managers in a world increasingly affected by globalization, technology and ethical challenges. It is designed for working professionals from a wide range of backgrounds who wish to advance or enhance their business careers.
The BSHA curriculum addresses the basic body of knowledge, understanding, and skills identified as relevant to health care services such as management, finance and accounting, legal and ethical parameters, health and disease factors, and human and information resources. In addition, the health information major provides the student with initial educational preparation to gain insight into the current and emerging world of health information systems. The reshaping of information and technology in health care requires workers to have a broad range of knowledge associated with the functions of an increasingly automated health care environment.
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