Insurance Resolution Specialist

About the role

PANTHERx is the nation’s largest rare disease pharmacy, dedicated to providing uncompromising quality and superior health outcomes for people living with rare and devastating diseases. As an Insurance Resolution Specialist, you will verify patient pharmacy and medical claims accurately and quickly, liaising between patients, insurance companies, and government agencies to ensure timely medication delivery and proper billing.

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 the patient’s behalf.
• Obtains authorizations and overrides as needed in coordination with insurance providers.
• Processes patient information for copay cards and/or assistance programs.
• Discusses and reviews patient financial responsibility, obtains patient consent and payment.
• Ensures proper shipment set-up of prescriptions.
• Supports special projects and other tasks 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.

Preferred 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+.

Work Environment

This position operates in a home or professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

Physical Demands

While performing the duties of this job, the employee is regularly required to sit, see, talk, or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Visual acuity is necessary for tasks such as reading or working with various forms of data for extended periods on a computer screen. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

Benefits

• Hybrid, remote, and flexible on-site work schedules (based on position).
• Medical, dental, and vision coverage.
• Health savings and flexible spending accounts.
• 401K with employer matching.
• Employer-paid life insurance and short/long-term disability coverage.
• Employee Assistance Program.
• Generous paid time off for full-time employees, with limited paid time off for part-time employees.
• Paid holidays.

Location: Pittsburgh, PA (Hybrid) | Classification: Non-Exempt | Status: Full-Time