Insurance Verification Specialist

We are currently seeking a dedicated Insurance Verification Specialist to join our team! If you are passionate about improving patient care and have experience in healthcare, particularly in pharmacy or insurance verification, we want to hear from you.

• Location: Robinson Township
• Type: Full-Time / Onsite
• Pay: $19-20/hour

This is for a Pharmacy Technology Company that helps patients get better access and prices to their prescription medications.

Responsibilities:

• Pharmacy Claims Processing: Accurately and timely process pharmacy claims to meet client expectations.
• Claims Triaging: Analyze and triage rejected pharmacy insurance claims to determine patient coverage.
• Prior Authorization Requests: Assist in initiating new prior authorization requests with providers and identify the correct forms needed based on patient insurance.
• Coordination with Providers: Collaborate with prescribers and medical offices to ensure all necessary information is accurately provided on prior authorization forms.
• Status Follow-Up: Regularly follow up with medical offices to check the status of prior authorization requests and communicate updates to patients and providers.
• Appeals Management: Work with medical offices to handle appeals as needed.
• Interdepartmental Support:Address internal inquiries related to prior authorization requests.
• Compliance Maintenance: Ensure compliance with patient assistance program guidelines and document all findings according to operating procedures.
• Research & Confidentiality: Conduct necessary research using available resources while maintaining the confidentiality of patient and proprietary information.

Requirements:

Education: High school diploma or GED required; Bachelor's degree preferred.

Experience: Minimum one year of healthcare experience, preferably in pharmacy, resolving third-party claims.

Skills:

• Strong verbal and written communication skills.
• Technical proficiency and analytical ability.
• Excellent judgment and operational focus.
• A commitment to providing exceptional patient care.
• Ability to work collaboratively with peers and across departments.
• Strong aptitude for learning complex software systems.

Work Schedule:

Hours: Monday - Friday: 8:00 AM - 9:30 PM, Saturday: 9:00 AM - 5:00 PM. (40 Hours a week)

• Flexibility Required: During Q4, candidates must be flexible to work an 8-hour shift within the operating hours. One Saturday a month is expected, with a midweek day off scheduled in return. Schedules will be provided with approximately two weeks' notice.

We are particularly interested in candidates with experience in:

- Pharmacy Business Office / Pharmacy Technician roles

- Physician Office or Hospital - RCM/Business Office/Front Desk

- Centralized Scheduling or Intake for healthcare organizations

- Claims processing or related health plan backgrounds

We encourage you to apply! If applicable, we will call you with further details!

We look forward to welcoming you to our team!