Senior Claims Specialist - Specialty Pharmacy

AssistRx•Maitland, FL

15d

About The Position

This role works directly with healthcare and pharmaceutical providers, as well as insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. You will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. Single point of contact for questions and inquiries from the prescriber, patient, and field agent by territory. Identifies applicable programs and facilitates next steps. Holistically executes case management tasks and communicates the statuses of all patient support activities. Liaison with other program-specific Assist resources to secure outcomes for active patients. Accepts inbound calls for assigned territory or overflow of other territories and provides one call resolution support. Ensures protection is insured. Answers inbound calls and makes outbound calls to introduce services. Gathers patient data, addresses the needs of the patient and reviews insurance benefits. Records the call details in patient data system. Contacts insurers for verification of benefits. Handles difficult patient situations when they arise. Conducts follow-up with pharmacies. Performs other related duties as assigned by management.

Requirements

College degree is preferred or high school diploma; equivalent combination of education and experience is also considered.
Previous work experience in Medical and Pharmacy Reimbursement or Customer Service.
Submitting billing data to appropriate insurance providers
Processing claims and resolving denial instances.
Achieving maximum reimbursement for services provided
Completing Medicare, Medicaid and Commercial insurance claim submission.
Documenting and reporting payment information.
Professional level skills in computer use, including but not limited to Microsoft Office, email, web-based applications, and keyboard skills.
Demonstrated strong written and verbal communication skills with providers, patients and insurance companies.
Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics.
Problem solving skills.

Responsibilities

Gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product
Support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues
Single point of contact for questions and inquiries from the prescriber, patient, and field agent by territory
Identifies applicable programs and facilitates next steps
Holistically executes case management tasks and communicates the statuses of all patient support activities
Liaison with other program-specific Assist resources to secure outcomes for active patients
Accepts inbound calls for assigned territory or overflow of other territories and provides one call resolution support
Ensures protection is insured
Answers inbound calls and makes outbound calls to introduce services
Gathers patient data, addresses the needs of the patient and reviews insurance benefits
Records the call details in patient data system
Contacts insurers for verification of benefits
Handles difficult patient situations when they arise
Conducts follow-up with pharmacies
Performs other related duties as assigned by management

Benefits

Supportive, progressive, fast-paced environment
Competitive pay structure
Matching 401(k) with immediate vesting
Medical, dental, vision, life, & short-term disability insurance
Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary.
Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
Many associates earn the opportunity to work from home after 120 days.
Flexible and inclusive work culture that values work-life balance and diverse perspectives.
We prioritize a “promote from within mentality”.
We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
Tell your friends about us! If hired, receive a $750 referral bonus!