Insurance Resolution Specialist

PANTHERx Rare Pharmacy; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401K with employer match

Life insurance

Disability coverage

Employee Assistance Program

Paid time off

Paid holidays

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA (Hybrid) is seeking an Insurance Resolution Specialist to verify patient pharmacy and medical claims and liaise with patients, insurers, and government agencies to ensure accurate billing and timely medication access.

The role requires a high school diploma, 2+ years of claims processing experience, and strong communication skills; proficiency with CMM, EDS, Excel, and Word is preferred.

Qualifications

• High school diploma or GED is required.
• Minimum 2 years’ experience processing pharmacy claims and benefit investigation.
• Strong written and verbal communication skills to convey ideas professionally.
• Ability to multitask and manage multiple claims efficiently.
• Proficiency 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 and overrides as needed in coordination with insurers.
• Processes patient information for copay cards and/or assistance programs.
• Discusses patient financial responsibility and obtains consent and payment.

Skills

Pharmacy claims

Benefit verification

Communication

Multitasking

Cover My Meds

EDS

Excel

Word

Education

High school diploma or GED

Tools

Cover My Meds (CMM)

EDS billing

Microsoft Excel

Microsoft Word

Job description

7,000 Diseases - 500 Treatments - 1 Rare Pharmacy

PANTHERx is the nation’s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do.

If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don’t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.

We Are Seeking Team Members Who

Are inspired and compassionate problem solvers;

Produce high quality work;

Thrive in the excitement of the ever-challenging environment of modern medicine; and

Are committed to achieving superior health outcomes for people living with rare and devastating diseases.

At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.

Join the PANTHERx team, and define your own RxARE future in healthcare!

Location: Pittsburgh, PA (Hybrid)

Classification: Non-Exempt

Status: Full-Time

Reports to: Supervisor, Patient Access

Purpose

The Insurance Resolution Specialist verifies patient pharmacy and medical claims accurately and quickly. This role liaises between patients, insurance companies, and government agencies to ensure patient receives medication accurately and timely and the appropriate entity is being billed.

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 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.

Required Qualifications

• High school diploma or general education degree (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.

Preferred Qualifications

• Experience or knowledge within the healthcare industry, particularly a mail order or specialty pharmacy.
• Strong understanding of benefit verification/prior authorization process.
• Experience with CPR+

Work Environment

This position operates in a home or professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands

While performing the duties of this job, the employee is regularly required to sit, see, talk, or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Visual acuity is necessary for tasks such as reading or working with various forms of data for extended periods on a computer screen. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.

Benefits

• Hybrid, remote and flexible on-site work schedules are available, based on the position.
• PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program!
• Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees.
• Of course we offer paid holidays too!

Equal Opportunity

PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.