Insurance Resolution Specialist

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

About PANTHERx

7000 Diseases 500 Treatments 1 Rare Pharmacy PANTHERx is the nations 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 dont 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

Classification

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 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

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 verificationprior 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 shortlong 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 veterans status or any other characteristic protected by federal state or local laws