Benefit Investigation Specialist - Extern

ConnectiveRx•Pittsburgh, PA

5d•Remote

About The Position

ConnectiveRx is seeking a compassionate Benefits Investigation Specialist to join their dynamic team. This role is crucial in ensuring patient access to essential medications by identifying and documenting coverage options for retail and specialty medications. The specialist will engage with Medical Insurance Payers and Pharmacy Benefit Managers to untangle the prescription process and create a clear path for patients.

Requirements

A high school diploma or equivalent is required.
Minimum of 2 years of experience in customer service, insurance, benefits, marketing, sales, or a related area is required, or a Bachelor's degree with one year of relevant experience.
Understanding of commercial insurance concepts, including coverage policies, major medical benefits, and knowledge of government and patient assistance programs.
Highly proficient in computer skills, including Microsoft tools, working from dual monitors, etc.
Strong email correspondence and personal documentation skills.
Fundamental analytic and problem-solving skills with excellent time management.
Demonstrated professional customer service experience with high attention to detail.
Be a critical thinker who is adaptable and results-driven.

Nice To Haves

A Bachelor's degree is preferred.
Preferred experience in a healthcare environment focusing on third-party benefits verification.

Responsibilities

Connect with Payers and Pharmacy Benefit Managers via outbound calls to verify patient insurance coverage and uncover available Medical and Pharmacy benefits.
Communicate case details to relevant internal or external parties, fostering effective collaboration.
Identify potential mechanisms for quick access to therapy by recognizing any payer coverage restrictions.
Showcase your ability to contribute effectively, whether working independently or in small workgroups.
Meet production and time completion goals with a focus on maintaining high-quality customer service standards in accordance with federal and state regulations.
Accurately document payer Prior Authorization and Appeals protocols, ensuring meticulous attention to detail.
Participate in special projects and embrace additional duties as required, contributing to a dynamic work environment.
Maintain a comprehensive repository of payer or brand-specific coverage information.
Engage in training and process improvement initiatives to enhance your professional growth.