Insurance Coordinator - Specialty Pharmacy

Optime Care • Earth City, MO

5d • Hybrid

About The Position

Optime Care is seeking an Insurance Coordinator. We are looking for someone who is passionate about helping people get the specialized therapies they need. This critical role will assist uninsured and underinsured patients in obtaining insurance coverage. They will assess each patient’s overall healthcare needs and explain coverage options available to them in their area. patient advocates to guide patients through the process of obtaining pharmaceuticals not available through chain pharmacies.
This position is eligible to become a hybrid role, with the opportunity to work remotely 1 or 2 days per week after an introductory period, depending on business needs.

Requirements

• A high school diploma or equivalent is required.
• 2 or more years of experience with medical/pharmacy insurance claims, billing, and/or benefit investigation.
• Extensive knowledge of state Medicaid plans, Medicare Part D plans, and ACA plans.
• Knowledge of medical/pharmacy insurance benefit language; ie. EOB’s, deductibles, out-of-pocket, coinsurance, co-pays, etc.
• Knowledge of Medicare and Medicaid billing
• Computer literate and proficient with Microsoft Office.
• Ability to participate in and facilitate group meetings.
• Ability to thrive in a fast-paced environment with constantly changing and competing priorities.
• Excellent analytical skills and the ability to provide solutions to complex problems.
• Ability to be highly transparent, ethical, and driven.
• Relentless attention to detail, and the ability to be a creative self-starter and team player.
• Excellent written and verbal communication skills, and interpersonal skills required.

Nice To Haves

• A college degree, Associate's or Bachelor's, is preferred.
• Knowledge of medical terminology and diagnosis codes is helpful.
• Missouri Pharmacy Technician license or willingness to obtain one once employed.
• Patient Assistance Program knowledge a plus
• Willingness to work a flexible schedule.

Responsibilities

• Communicate directly with patients to evaluate their specific needs and to assess insurance options.
• Act as a patient advocate to gain insurance coverage for prescribed therapies.
• Recommend insurance policies to patients by evaluating their needs.
• Investigate and explain benefit plans and details to the patient.
• Keep up-to-date with developments in the insurance market, staying informed of industry trends and changes.
• Maintain accurate records of patient interactions within the pharmacy management system.
• Collaborate and strategize with team members regarding patient cases.
• Provide day-to-day communication on patient case statuses between team members.
• Assist patients with financial assistance resources.
• Assist with preparing any ad hoc client report requests.
• Monitor external websites relating to therapy areas, specifically around coverage updates or changes.
• Monitor system payers for appropriate and complete information.
• Other duties as needed or assigned by the business.

Benefits

• Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED