Insurance Verification Specialist - Specialty Pharmacy

About the role

The purpose of this position is to help patients get access to the medications and therapies that they need.

Responsibilities

• Works directly with healthcare providers & insurance plans/payers to gather information about a patient's insurance and the coverage provided for a specific pharmaceutical product.
• Supports healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues.
• Supports Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications.
• Ensures cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality.
• Conducts benefit investigations for patients by making outbound phone calls to payers to verify patient insurance benefit information, navigate complex reimbursement barriers, and seek resources to overcome the barriers.
• Verifies patient specific benefits and documents specifics including coverage, cost share, and access/provider options.
• Identifies any coverage restrictions and details on how to expedite patient access.
• Documents and initiates prior authorization process and claims appeals.
• Reports any reimbursement trends or delays in coverage to management.
• Acts as a liaison for field representatives, health care providers, and patients.

Requirements

• In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage.
• 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage.
• 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements.
• Excellent verbal communication skills and grammar.
• Preferred: Salesforce system experience.

Qualifications

• High school diploma or equivalent.
• Experience working with healthcare providers and insurance plans.
• Strong problem-solving and organizational skills.
• Ability to communicate effectively both verbally and in writing.

Skills

• Strong understanding of major medical and pharmacy benefit coverage.
• Experience with insurance verification and prior authorizations.
• Excellent communication and interpersonal skills.
• Proficiency in Salesforce (preferred).

Benefits

• Medical, dental, vision, life, and short-term disability insurance.
• Teledoc services for those enrolled in medical insurance.
• Supportive, progressive, fast-paced environment.
• Competitive pay structure.
• Matching 401(k) with immediate vesting.
• Legal insurance.

Company Culture

• Work Hard, Play Hard: 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.
• Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
• Flexible Culture: Many associates earn the opportunity to work a hybrid schedule after 120 days after training.
• Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
• Career Growth: We prioritize a "promote from within mentality". We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
• Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
• Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible.

Company Recognition

• #TransformingLives Honor: This quarterly award program is a peer to peer honor that recognizes and highlights some of the amazing ways that our team members are transforming lives for patients on a daily basis.
• Values Award: This quarterly award program recognizes individuals who exhibit one, or many, of our core company values; Excellence, Winning, Respect, Inspiration, and Teamwork.
• Vision Award: This annual award program recognizes an individual who has gone above and beyond to support the AssistRx vision to transform lives through access to therapy.

Pay and Schedule

Compensation: $19-22/hr

Location(s): 2160 E. Elliot Road, Tempe, AZ 85283

Onsite Requirement: This role does require onsite availability, but may offer hybrid and/or remote opportunities once requirements are met.

Schedule

Flexible schedule with potential for remote work after meeting requirements.

Benefits

• Medical, dental, vision, life, and short-term disability insurance.
• Teledoc services for those enrolled in medical insurance.
• Supportive, progressive, fast-paced environment.
• Competitive pay structure.
• Matching 401(k) with immediate vesting.
• Legal insurance.

Equal Opportunity Employer

All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws. All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position. AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.