The Cystic Fibrosis Foundation (CF Foundation) and its employees embrace their commitment to its core values. These core values are the pillars on which the CF Foundation stand and will continue to sustain us as we move forward.
- Keep sight of what really matters: Our decisions are based on what is best for people with cystic fibrosis and their families.
- Aspire for excellence in all we do: We take pride in our work. We are committed to continuous learning and improvement.
- Stronger together: We collaborate and work together so that we can learn more and achieve more.
- Innovate with courage: We embrace challenges. We reach beyond boundaries in pursuit of our vision.
- Care about our people: We deeply care about each other and all who support our shared mission. We listen with respect. We support one another.
- Conduct intake, screening, assessment, coverage and reimbursement/prior authorization/appeal research and triage to appropriate resources for customers who contact CFF Compass.
- Enter customer information and track disposition of cases into the database. Position serves as subject-matter expert in area of coverage and reimbursement and requires ability to work on cases independently with minimal supervision.
- Collaborate with internal and external customers and to properly triage cases to the appropriate groups as needed.
- Demonstrate ability to multitask — working on primary responsibilities while participating in ongoing and ad hoc projects.
- Perform the above job functions from the local CF Foundation chapter, and report to and coordinate with the National Office Compass staff for daily responsibilities.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Follows department standard operating procedures and internal policies.
- Exhibits and maintains confidentiality pertaining to patient health information.
- Reviews & evaluates patient cases with support from lead case manager to educate callers regarding how to determine insurance benefits for coverage of drug(s) and/ or devices.
- Assists callers with initiating and/or completing prior authorizations or appeals for insurance denials. Provides support documents as needed.
- Assesses whether patients qualify for co-pay assistance programs or programs for the uninsured and triages callers to the appropriate program(s) as needed.
- Assesses whether patients qualify for federal/state programs, provides guidance and triages as appropriate.
- Enters customer information into the database and creates appropriate service requests and designates to the appropriate agent as needed.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
- Bilingual in Spanish and English is highly preferred
- Bachelor’s degree preferred
- Two years minimum experience in a healthcare or patient support services environment
- Knowledge of Medicare coverage and reimbursement
- Experience determining Medicaid/SSI/SSDI eligibility
- Knowledge of third party payers, private (both local and national), federal, and state
- Experience with co-pay Foundations and patient assistance programs
- Experience conducting benefit investigations, prior authorizations, and appeals
- Basic computer skills necessary, including Internet, Oracle/Microsoft Dynamics CRM, MS Word, Excel, and Microsoft Outlook
The CF Foundation is an equal opportunity employer that is committed to being an employer of choice, not just a good place to work, but a great and inclusive place to work. We strive to recruit and maintain a diverse workforce. Qualified applicants will receive consideration for employment without regard to race, physical or mental disability, color, religious creed, ancestry, national origin, religion, age, sex, marital status, genetic information or testing, gender identity and expression, sexual orientation or status as a Vietnam-era or special disabled veteran or any characteristic protected by law.
Reasonable Accommodation Notice
The CF Foundation is committed to providing reasonable accommodations for qualified individuals with disabilities in our job application procedures. If you need assistance or would like to request an accommodation due to a disability, please contact us at HROps@cff.org .