Charnetta Lane

Verifies all benefit information needed to process a claim under pharmacy coverage. Processes pharmacy claims on the patient’s behalf through a pharmacy benefit system. Verifies medical benefits accurately on the patient’s behalf. Obtains authorizations & overrides as needed in coordination with insurance providers. Processes patient information for copay cards and/or assistance programs. Discusses patient financial responsibility with patients and obtains patient consent and payment. Ensures proper shipment setup of prescriptions. Supports special projects
Other tasks as assigned.

Receives and responds to incoming mail from the website; processes incoming written correspondence, makes follow-up calls, and emails correspondence; provides additional information to consumers; responds to complaints promptly according to complaint policy. Makes appropriate suggestions for dispute resolutions and notifies consumers of other options for seeking resolution when necessary; provides informal conciliation and counseling for consumers and companies. Coordinates information requirements for arbitration and arranges hearings for parties involved. Explain to the consumer by telephone, email, or letter the action taken on the complaint; follow up with the consumer to ensure that the complaint was satisfactorily resolved. Researches, analyzes, reports, and protects sensitive and confidential information for conciliation and settlement purposes. Publish complaints and consumer reviews on the national Better Business Bureau website.

Reviews and edits accounts from various work lists of accounts for such actions as third-party rebilling, adjustment posting, collection agency referral, or other options to appropriately resolve account balance. Make appropriate adjustments to the accounts receivable systems. Responds to patient inquiries/concerns received by telephone, mail, or in-person. Documents of the accounts receivable system with all pertinent information regarding the patient interview, research performed, and issue resolution. Collects payments on account as appropriate. Establishes payment terms, negotiates settlements, and screens for patient/guarantors' eligibility for charity discounts.

Issues with benefit determination letters, pension calculations, and payment authorizations. Creates written correspondence to pension participant. Input data into various PBGC administrative tools and databases. Completes a review of participant applications to determine eligibility. Responds to participant calls and facilitates requests. Processes benefit applications, Payments, Annuities, Back Payments, and lump sum payments, creating customized letters from the EALG system, processes deaths in the FBA System, and stops and reissues outstanding checks from the PLUS system. Update, change, and delete participant information in the Spectrum system.