Insurance Resolution Specialist

Responsibilities

• Verifies all benefit information needed to process a claim under pharmacy or medical coverage.
• Processes pharmacy claims on the patient’s behalf through a pharmacy benefit system.
• Verifies medical benefits accurately on patient’s behalf.
• Obtains authorizations & overrides as needed in coordination with insurance providers.
• Processes patient information for copay cards and/or assistance programs.
• Discusses with patients a review of patient financial responsibility, and obtains patient consent and payment.
• Safeguards proper shipment set up of prescriptions.
• Supports special projects as assigned.

Requirements

• High school diploma or general education degree (GED).
• Minimum 2 years’ experience processing pharmacy claims and benefit investigation.
• Strong written and verbal communication skills necessary to convey ideas professionally and effectively.
• Ability to multitask.
• Proficient with Cover My Meds (CMM), EDS billing systems, Excel, and Word.

Qualifications

• Experience or knowledge within the healthcare industry, particularly a mail order or specialty pharmacy.
• Strong understanding of benefit verification/prior authorization process.
• Experience with CPR+

Benefits

• Hybrid, remote and flexible on-site work schedules are available, based on the position.
• Affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!
• Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.
• Of course we offer paid holidays too!