Hybrid Insurance Resolution Specialist - Rare Pharmacy

Pantherx Specialty LLC; United States; Hybrid; USD 42,000 - 64,000; Full time

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA seeks an Insurance Resolution Specialist to verify patient pharmacy and medical claims accurately and quickly. This role liaises between patients, insurance companies and government agencies to ensure timely medication billing.

Hybrid, full-time, reports to Supervisor Patient Access. Requires high school diploma and minimum 2 years claims experience; proficiency with CMM, EDS, Excel and Word; strong communication and multitasking skills.

Qualifications

• High school diploma or 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.

Responsibilities

• Verifies all benefit information needed to process a claim under pharmacy or medical coverage.
• Processes pharmacy claims on the patients behalf through a pharmacy benefit system.
• Verifies medical benefits accurately on patients behalf.
• Obtains authorizations & overrides as needed in coordination with insurance providers.
• Processes patient information for copay cards andor assistance programs.
• Discusses with patients a review of patient financial responsibility and obtains patient consent and payment.
• Ensures proper shipment set up of prescriptions.
• Supports special projects.
• Other tasks as assigned

Skills

Written and verbal communication

Multitasking

Education

High school diploma or GED

Tools

Cover My Meds

CMM

EDS Billing

Excel

Word

Job description

PANTHERx Rare Pharmacy in Pittsburgh, PA seeks an Insurance Resolution Specialist to verify patient pharmacy and medical claims accurately and quickly. This role liaises between patients, insurance companies and government agencies to ensure timely medication billing.

Hybrid, full-time, reports to Supervisor Patient Access. Requires high school diploma and minimum 2 years claims experience; proficiency with CMM, EDS, Excel and Word; strong communication and multitasking skills.