Insurance Analyst I

Spectraforce Technologies; North Chicago (IL); Remote; USD 40,000 - 65,000; Full time

Job summary

An innovative firm seeks an Insurance Analyst I to deliver exceptional customer service to patients and healthcare providers. This role is pivotal in managing insurance benefits, processing prior authorizations, and ensuring smooth communication between departments and payors. As a subject matter expert, you'll handle patient inquiries and collaborate with pharmacy teams to maximize access to care. Ideal candidates will possess strong organizational and communication skills, with a background in healthcare or reimbursement. Join this dynamic team and make a meaningful impact on patient access to essential therapies.

Qualifications

• 1-3 years of healthcare or reimbursement experience is preferred.
• Knowledge of pharmacy and medical insurance programs is essential.

Responsibilities

• Provide expertise on medical and prescription insurance coverage.
• Accurately document information in the appropriate systems.
• Monitor referral status to ensure rapid turnaround for drug procurement.

Skills

Customer Service

Insurance Billing

Claims Processing

Prior Authorization

Communication Skills

Organizational Skills

Education

High School Diploma or GED

Degree in Healthcare or Related Field

Tools

Microsoft Office

Job description

Job Title: Insurance Analyst I

Duration: 6 Months

Location: (Remote)

Shift Hours: During training, the hours would be 8am-4:30pm CST. Once the technician is released to the floor, any 8 hours between 7am-7pm CST can be the shift timing.

Shift after training will likely be from 10:30am-7pm CST, so it is essential that candidates are okay with working this shift.

Purpose

The primary function of the Insurance Analyst I is to provide best-in-class customer service to patients, Healthcare Providers (HCPs), and their staff through referral and call management by investigating patients' insurance benefits and financial assistance opportunities, as well as processing and monitoring prior authorizations to assist patients in starting or continuing therapy. This position will be a subject matter expert in insurance billing, claims processing, and prior authorizations. It liaises between departments, payors, and providers to determine patients' overall prescription coverage. The Insurance Analyst I handles patient requests received by phone or electronically (fax, Humira Complete Pro, or other systems) and completes related outbound calls. The role collaborates with other areas of the Pharmacy to maximize patient access to care.

Responsibilities

• Provide expertise on medical and prescription insurance coverage/verification, claim billing, medication prior authorization and appeal filing, and financial assistance opportunities.
• Accurately document information in the appropriate systems and formats.
• Communicate the status of referrals to physicians and patients via phone, fax, and pharmacy systems as per policies.
• Assist with documentation and filing for prior authorizations and appeals.
• Monitor referral status to ensure rapid turnaround for drug procurement, collaborating with insurance payors and providers.
• Maintain and update payor intelligence resources.
• Meet or exceed departmental performance metrics.
• Take responsibility for daily tasks and provide progress reports on goals and metrics.
• Identify opportunities for process improvement and troubleshoot issues, taking ownership as needed.
• Decide on benefit verification investigations or acceptances based on reasonableness and accuracy; escalate issues to management when necessary.
• Enter patient demographic and insurance information into the system and notify physicians of any discrepancies.
• Comply with all training requirements, pharmacy laws, HIPAA policies, and internal procedures.
• Identify potential adverse events for reporting to Pharmacovigilance.
• Complete all required training and perform additional tasks as assigned.

Qualifications

• High school diploma or GED required; degree preferred.
• 1-3 years of healthcare or reimbursement experience, call center experience preferred.
• Knowledge of pharmacy and medical insurance programs, billing, funding resources, reimbursement, prior authorization, and specialty pharmacy operations.
• Strong team, organizational, and communication skills with attention to detail.
• Proficiency with Microsoft Office and ability to learn new systems.