Insurance Verification Representative

Healthcare Support Staffing; Pittsburgh (Allegheny County); On-site; USD 45,000 - 55,000; Full time

Benefits offered by this job

Competitive salary

Medical benefits

Dental benefits

Vision benefits

Positive work environment

Job summary

A healthcare staffing firm based in Allegheny County, Pittsburgh, is seeking a patient eligibility coordinator. Key responsibilities include verifying insurance coverage, managing prior authorizations, and coordinating benefits. Ideal candidates should have a high school diploma, one year of insurance verification experience, and strong data entry skills. This role offers a competitive salary and benefits in a fun, positive work environment, operating Monday through Friday from 8 am to 5 pm.

Qualifications

• 1 year of insurance verification and/or pharmacy technician experience.
• At least 6 months specialty pharmacy experience.
• Understanding of claims processes.
• Experience in obtaining prior authorizations.

Responsibilities

• Verify patient eligibility and insurance coverage.
• Coordinate benefits investigation and manage prior authorizations.
• Notify patients and clinics of any financial responsibilities.
• Complete full Medical Verification for medications, supplies and related services.
• Notify patients and physicians of financial responsibility and delays.
• Assist with pharmacy and major medical claims and resolve insurance rejections.
• Handle urgent notifications to senior staff and communicate with departments for urgent fills or deliveries; place outbound calls as needed.
• Manage inbound calls on the Insurance line regarding services and coverage questions.

Skills

Insurance verification

Pharmacy technician experience

Data entry skills

Basic Microsoft Excel

Basic Microsoft Word

Education

High School Diploma/GED

Tools

Microsoft Excel

Microsoft Word

Job description

s an American company which operates as the second-largest pharmacy store chain in the United States.

• Treatment of complex, chronic, and/or rare conditions
• High cost, often exceeding $10,000, with some costing more than $100,000 annually
• Availability through exclusive, restricted, or limited distribution
• Special storage, handling, and/or administration requirements
• Ongoing monitoring for safety and/or efficacy

Job Description

Responsible for verifying patient eligibility, coordinating benefits, claims and determining patientcoverage/responsibility for services including, but not limited to primarily major medical insurance benefitsverification, complex insurance plan verification and high volume PBM plans. Also responsible
for the coordination of benefits investigation and partnering with patient assistance programs.

Essential Functions:

• Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file.
• Verifies patient insurance coverage of medications, administration supplies and related pharmacy services.
• Facilitates and completes the Prior Authorization process with insurance companies and practitioner offices.
• Completes a full Medical Verification for all medications, administration supplies and related pharmacy services.
• Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility.
• Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization any other insurance rejections.
• Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary; Places outbound calls to patients or physicians offices to obtain additional information needed to process the script or to notify of delay in processing script.
• Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.

Qualifications

• High School Diploma/GED
• 1 year insurance verification and/or pharmacy technician experience OR at least 6 months specialty pharmacy experience.
• Understanding ofclaims processes
• Understanding the authorization process is a must.
• At least 1 year experience in obtaining prior authorizations from apharmacy benefit or medical billing experience
• Needs to have an understanding of Commercial Insurance, Medicare and Medicaid - Please make sure this is on the resume
• Strong Data Entry Skills
• Basic level skill in Microsoft Excel (for example: opening a workbook, inserting a row, selecting font style and size, formatting cells as currency, using copy, paste and save functions, aligning text, selecting cells, renaming a worksheet, inserting a column, selecting a chart style, inserting a worksheet, setting margins, selecting page orientation, using spell check and/or printing worksheets)
• Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures and dates, using find and replace, undo, spell check, track changes, review pane and/or print functions)

Additional Information

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm