Benefits Verification Representative

Orsini - Rare Disease Pharmacy Solutions; Elk Grove Village (IL); Hybrid; USD 39,312 - 48,048; Full time

Benefits offered by this job

Medical Coverage

401(k) with employer match

Generous PTO and paid holidays

Tuition reimbursement program

Job summary

JobRx, Inc. is seeking a Specialty Drug Processor based in Elk Grove Village, Illinois. The successful candidate will process requests for specialty drugs by verifying benefits and troubleshooting claims rejections. A strong understanding of major medical insurance and pharmacy benefits is essential.

We offer a hybrid work model along with a comprehensive benefits package, including medical coverage, 401(k) with employer match, and generous paid time off. Experience in a fast-paced environment is crucial.

Qualifications

• Experience with major medical insurance is required.
• Knowledge of pharmacy benefit structures is essential.
• Understanding HCPCs codes is necessary.

Responsibilities

• Process requests for specialty drugs and verify benefits.
• Submit prior authorization requests on new or recurring patients.
• Troubleshoot pharmacy claims rejections.

Skills

Major Medical Insurance experience

Knowledge of pharmacy benefits

Knowledge of HCPCs codes

Ability to multitask

Ability to work in a fast-paced environment

Intermediate knowledge of Microsoft Office

Intermediate knowledge of Adobe Acrobat

Job description

POSITION SUMMARY

This position will process request for specialty drug by verifying the benefits through major medical and pharmacy benefits. Troubleshoot any rejections and submit for prior authorizations request on new or recurring patients.

ESSENTIAL DUTIES

• Perform benefit verifications through the medical and pharmacy benefits.
• Submit and obtain Prior authorizations with insurance companies.
• Troubleshoot pharmacy claims rejection.
• Perform Monthly Re-verifications.
• Partner with Accounts Receivable to resolve benefit issues.
• Other duties and responsibilities as required.

DISCLAIMER

Disclaimer: The information written in this job description indicates the general nature and level of work to be performed. This job description is not designed to contain or be interpreted as totally comprehensive of every job duty, responsibility, or qualification required by an employee assigned to this job. While employed in this position, an employee may be required to perform other assignments not listed in this job description.

KNOWLEDGE, SKILLS, AND TRAINING

• Experience with Major Medical Insurance.
• Knowledge of pharmacy benefit.
• Knowledge of HCPCs codes.
• Able to multitask.
• Able to work well in a fast-paced working environment.
• Intermediate knowledge of Microsoft Office (Word, Excel, Outlook, Teams, etc.).
• Intermediate knowledge of Adobe Acrobat/PDF's.

EMPLOYEE BENEFITS

We offer a comprehensive benefits package designed to support your health, financial security, and overall well-being:

• Medical Coverage, Dental, and Vision Coverage
• 401(k) with employer match
• Accident and Critical Illness coverage
• Company-paid life insurance options
• Generous PTO, paid holidays, and floating holidays
• Tuition reimbursement program.

COMPENSATION & LOCATION

The salary range for this role is $21.00.

This position is Hybrid based out of our Elk Gove Village location.

EQUAL EMPLOYMENT OPPORTUNITY

Orsini Rare Disease Pharmacy Solutions is committed to the principle of Equal Employment Opportunity for all employees and applicants. It is our policy to ensure that both current and prospective employees are afforded equal employment opportunity without consideration of race, religious creed, color, national origin, nationality, ancestry, age, sex, marital status, sexual orientation, or present or past disability (unless the nature and extent of the disability precludes performance of the essential functions of the job with or without a reasonable accommodation) in accordance with local, state and federal laws.

AMERICANS WITH DISABILITIES ACT

Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

E-VERIFY PARTICIPATION NOTICE

We participate in the federal E-Verify program to confirm the identity and employment eligibility of all newly hired employees.

All offers of employment are contingent upon the successful completion of Form I-9 and verification through the E-Verify system.

For more information about E-Verify, please review the official notices below:

E-Verify Participation Poster (English & Spanish): https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf

Right to Work Poster (English & Spanish): https://www.e-verify.gov/sites/default/files/everify/posters/IER_RightToWorkPoster.pdf