Insurance Resolution Specialist — Hybrid (Patient Access)

PANTHERx Rare Pharmacy; Pittsburgh (Allegheny County); Hybrid; USD 25,000 - 36,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Health savings and flexible spending

401K with employer matching

Employer-paid life insurance

Short-term disability coverage

Long-term disability coverage

Employee Assistance Program

Generous paid time off

Paid holidays

Job summary

PANTHERx Rare Pharmacy in Pittsburgh, PA is seeking an Insurance Resolution Specialist (Mid Shift). The role verifies pharmacy and medical claims and coordinates with patients, insurers and government agencies to ensure accurate billing and timely medication delivery.

Shift options are 9:30AM–6:30PM or 10:00AM–6:30PM, Monday through Friday, with a full-time schedule. The ideal candidate has a high school diploma or GED and at least 2 years of experience processing claims and benefit

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 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.

Skills

Communication skills

Multitasking

Education

High school diploma or GED

Tools

Cover My Meds (CMM)

EDS billing systems

Excel

Word

Job description

PANTHERx Rare Pharmacy in Pittsburgh, PA is seeking an Insurance Resolution Specialist (Mid Shift). The role verifies pharmacy and medical claims and coordinates with patients, insurers and government agencies to ensure accurate billing and timely medication delivery.

Shift options are 9:30AM–6:30PM or 10:00AM–6:30PM, Monday through Friday, with a full-time schedule. The ideal candidate has a high school diploma or GED and at least 2 years of experience processing claims and benefit