Insurance Resolution Specialist (Second Shift)

About the role

PANTHERx is the nation’s largest rare disease pharmacy, dedicated to providing uncompromising quality and superior health outcomes for patients living with rare and devastating diseases. As an Insurance Resolution Specialist (Second Shift), 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 processes payments.
• 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.
• Strong written and verbal communication skills.
• 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 and 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 stands, walks, uses hands and fingers, handles or feels, and reaches with hands and arms. Visual acuity is necessary for tasks such as reading or working with data on a computer screen for extended periods. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

Schedule

This full-time, non-exempt position requires a shift of either 11 AM–8 PM or 11:30 AM–8 PM, Monday through Friday, or four 10-hour shifts.

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)

Reports to: Supervisor, Patient Access