Insurance Resolution Lead (Hybrid/Remote)

Pantherx Specialty LLC; Pittsburgh (Allegheny County); Hybrid; USD 60,000 - 86,000; Full time

Benefits offered by this job

Medical, dental, vision

401K with employer matching

Life insurance

Short/long-term disability

Employee Assistance Program

Generous paid time off

Job summary

PANTHERx Rare Pharmacy seeks a Lead Insurance Resolution Specialist to verify patient insurance coverage for drugs, nursing, supplies, and per diem services. You will enter benefit information into Panther’s RxARECARE system and support with staffing, training, and special projects.

The role requires a Bachelor's in business or related field, deep knowledge of medical/pharmacy insurance processes, and strong communication skills.

Qualifications

• Bachelor’s degree required; equivalent work experience may substitute.
• Detailed understanding of Medical and Pharmacy insurance verification processes with all payer types.
• Excellent oral and written communication skills with all levels of management.
• Strong problem-solving skills to evaluate and decide.
• Knowledge of Microsoft Office Suite: Excel, Outlook, PowerPoint; Cover My Meds a plus.
• Ability to thrive working independently.

Responsibilities

• Verify Pharmacy and Medical insurance benefit coverage for newly referred patients to Panther RxARECARE.
• Serve as liaison between staff and supervisors for day-to-day questions.
• Assist training or retraining of staff.
• Provide staffing relief across multiple drugs and projects.
• Monitor daily reports to align with company goals.
• Follow up with insurers, MD offices, and patients.
• Assist enrollments into co-pay, Bridge and PAP programs.
• Handle authorizations and payer overrides as needed.
• Research and follow-ups on authorization approvals, denials, and appeals.
• Process claims via NCPDP to payers and ensure payable outcomes.
• Re-verify coverage at shipment and set up proper shipping.
• Assist patients with program enrollments and manufacturer assistance.
• Work in a phone queue format for assigned drugs.
• Perform other duties as assigned.

Skills

Medical insurance verification

Pharmacy insurance verification

Microsoft Office

Communication skills

Independent work

Education

Bachelor’s degree in business or related field

Tools

Excel

Outlook

PowerPoint

Cover My Meds

Job description

PANTHERx Rare Pharmacy seeks a Lead Insurance Resolution Specialist to verify patient insurance coverage for drugs, nursing, supplies, and per diem services. You will enter benefit information into Panther’s RxARECARE system and support with staffing, training, and special projects.

The role requires a Bachelor's in business or related field, deep knowledge of medical/pharmacy insurance processes, and strong communication skills.