Senior Claims Specialist - Specialty Pharmacy

AssistRx • Maitland, FL

3d

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.
• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

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.
• We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
• If hired, receive a $750 referral bonus!

What This Job Offers

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