Lead Insurance Resolution Specialist

PANTHERx Rare Pharmacy; Pittsburgh (Allegheny County); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, vision

HSA/FSA

401K with employer matching

Life insurance

Disability coverage

Employee Assistance Program

Paid time off

Paid holidays

Job summary

PANTHERx Rare Pharmacy is seeking a Lead Insurance Resolution Specialist in Pittsburgh, PA to verify insurance coverage for drugs, nursing, supplies, pumps, and per diem charges. This role ensures timely entry of benefit information into Panther’s RxARECARE system and supports the supervisor with daily team questions.

The position requires a Bachelor’s degree and extensive knowledge of medical and pharmacy payer verification, with strong communication and independent work skills.

Qualifications

• Bachelor’s degree in business or related field required; equivalent work experience may substitute.
• Detailed understanding of medical/pharmacy insurance verification for all payer types.
• Excellent oral and written communication skills and able to communicate effectively with all levels of management.
• Strong problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make timely decisions.
• Knowledge of Microsoft Office Suite, especially Excel, Outlook, and PowerPoint; Cover My Meds is a plus.
• Ability to thrive working independently.
• 2+ years of specialty pharmacy insurance verification knowledge.

Responsibilities

• Verifies Pharmacy and Medical insurance benefit coverage for newly referred patients to Panther RxARECARE.
• Acts as a liaison between staff and supervisors to assist with day-to-day questions.
• Assists with training or re-training efforts of staff.
• Understands multiple drug processes to provide temporary staffing relief.
• Works on special projects as needed.
• Monitors daily reports to ensure business objectives align with company goals.
• Follows up with insurance payors, MD offices, and patients.
• Collects clinical information to initiate authorizations for MDOs or patients.
• Submits authorizations and overrides as needed for drug, nursing and per diem charges.
• Researches and follows up on authorization approvals, denials, and appeals.
• Processes claims via NCPDP to payers.
• Works all rejections until payable claim is achieved.
• Re-verifies insurance coverage at shipment time.
• Assists patients with enrollments into manufacturer co-pay assistance programs or foundations; Bridge and PAP programs.
• Works with a phone queue format for assigned drugs.
• Other duties as assigned within scope of job responsibilities.

Skills

Medical insurance verification

Communication skills

Problem solving

Independent work

Excel proficiency

Office suite

Education

Bachelor’s degree in business or related field

Tools

Cover My Meds

Microsoft Office

NCPDP

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

Classification

Non-Exempt

Status

Full-Time

Reports to

Supervisor, Patient Access

Purpose

The Lead Insurance Resolution Specialist verifies patient insurance coverage to ensure drugs, nursing, supplies, pumps, and per diem charges are covered by an individual’s healthcare provider. This role enters the patient’s insurance benefit information timely and accurately into Panther’s RxARECARE operating system. The Lead Insurance Resolutions Specialist assists the supervisor with day-to-day team questions, possess knowledge to work on multiple drugs, and assists with staffing shortages, training efforts. This position works with special projects as needed.

Responsibilities

• Verifies Pharmacy and Medical insurance benefit coverage for newly referred patients to Panther RxARECARE.
• Acts as a liaison between the staff and supervisors to assist with day-to-day questions.
• Assists with training or re-training efforts of staff.
• Understands multiple drug processes to provide temporary staffing relief.
• Works on special projects as needed.
• Monitors various daily reports to ensure business objectives are in line with company goals.
• Follows up with insurance payors, MD offices, and patients.
• Collects clinical information from MDO’s, hospitals, and/or facilities to initiate authorizations on behalf of the MDO or patient.
• Submits and obtains authorizations and payer overrides as needed for drug, nursing and per diem charges when applicable.
• Researches and follow ups on authorization approvals, denials, and appeals.
• Processes claims via NCPDP to payers.
• Works all rejections until payable claim is achieved.
• Re-verifies insurance coverage at time of shipment and ensures proper shipment set up.
• Assists patients with enrollments into manufacturer co-pay assistance programs or foundations.
• Assists patients when eligible with enrollment into Bridge and PAP programs.
• Abilities to work within a phone queue format for assigned drugs.
• Other duties as assigned within scope of job responsibilities.

Required Qualifications

• Bachelor’s degree in business or related field required. Equivalent work experience may substitute education requirements.
• Detailed understanding of both Medical and Pharmacy insurance verification processes with all payer types.
• Excellent oral and written communication skills and able to communicate effectively with all levels of management.
• Strong problem-solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make appropriate and timely decisions.
• Knowledge of Microsoft Office Suite, especially Excel, Outlook, and PowerPoint. Knowledge of Cover My Meds a plus.
• Uses tact, sensitivity, sound judgement, and a professional attitude constantly.
• Ability to thrive working independently.

Preferred Qualifications

• 2+ years of specialty pharmacy insurance verification knowledge.

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.