Hybrid Insurance Resolution Specialist: Patient Access

PANTHERx Rare Pharmacy; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Hybrid work

Medical, dental, vision benefits

401K with employer matching

Life insurance

Paid time off

Paid holidays

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA, seeks an Insurance Resolution Specialist to verify patient pharmacy and medical claims quickly and accurately. You will liaise with patients, insurance companies, and government agencies to ensure timely medication delivery and proper billing.

The role requires a high school diploma, at least two years in processing pharmacy claims, and strong communication. Hybrid work options and a comprehensive benefits package are offered to support patient care and

Qualifications

• High school diploma or GED is required.
• Minimum 2 years’ experience processing pharmacy claims and benefit investigation.
• Proficient with CMM, EDS billing systems, Excel and Word.

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 patient financial responsibility and obtains consent and payment.
• Ensures proper shipment set up of prescriptions.
• Supports special projects
• Other tasks as assigned.

Skills

Communication skills

Multitasking

Education

High school diploma or GED

Tools

Cover My Meds (CMM)

EDS billing systems

Excel

Word

Job description

PANTHERx Rare Pharmacy in Pittsburgh, PA, seeks an Insurance Resolution Specialist to verify patient pharmacy and medical claims quickly and accurately. You will liaise with patients, insurance companies, and government agencies to ensure timely medication delivery and proper billing.

The role requires a high school diploma, at least two years in processing pharmacy claims, and strong communication. Hybrid work options and a comprehensive benefits package are offered to support patient care and