Medical Benefits Specialist

Asembi; Livingston (NJ); On-site; USD 60,000 - 78,000; Full time

Job summary

Asembia is seeking a Medical Benefits Specialist in Livingston, NJ to support client insurance coverage education, prior authorizations, and claims resolution.

The role emphasizes HIPAA compliance, data accuracy, and exceptional service to providers, patients, and payors, with standard hours and potential shift variations.

Qualifications

• Bachelor's degree; or 5 years experience in Member/Provider Services or Claims.
• Prior authorization/appeals experience preferred.
• Knowledge of medical terminology.
• Knowledge of 3rd party payors and prior authorizations processes.
• Ability to manage multiple tasks with strong organizational skills.
• Excellent written and verbal communication, and proofreading skills.
• Ability to preserve confidentiality of PHI.

Responsibilities

• Educate clients and healthcare teams on insurance coverage components (Medical and Prescription).
• Research billing issues and contact carriers to resolve claim issues.
• Advocate for patients in prior authorization, denials and appeals.
• Manage time-sensitive task completion on referrals and prior authorizations.
• Interact professionally with internal partners and external providers, carriers, patients, and stakeholders.
• Monitor trends and escalate actions to improve service outcomes.
• Maintain regular attendance and punctuality.
• Comply with HIPAA regulations.

Skills

Medical terminology

Prior Authorization

Member Services

Communication skills

Problem-solving

PHI confidentiality

Education

Bachelor's degree

Tools

MS Word

Excel

Outlook

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Medical Benefits Specialist

Full Time Regular Technical Livingston, NJ - Patient Support Center, Livingston, NJ, US

Asembia is seeking a Medical Benefits Specialist for our organization. Our teams are comprised of passionate and motivated professionals; and through collaborative programs, contracting initiatives, patient support hub services and innovative technology platforms, Asembia is committed to positively impacting the patient journey. We offer our employees the latitude required for professional growth and career advancement.

The incumbent is responsible for executing program requirements, managing daily workflow, providing accurate and complete data input, managing pre-certifications and providing high levels of customer service.

Work shifts may vary: The pharmacies operating hours are Monday through Friday from 8:00 a.m. - 11:00 p.m. (EST), and Saturday and Sunday from 8:00 a.m. - 8:00 p.m. (EST)

Job Scope and Major Responsibilities:

• Educating clients and their healthcare team on the components of their insurance coverage, including Medical and Prescription benefits.
• Research billing issues and contact insurance carriers to resolve claim issues
• Advocating for patients/clients in the prior authorization process, including denials and appeals.
• Manage time sensitive task completion on referral and prior authorization submissions
• Ability to interact professionally with not only internal matrix partners, but external contacts such as providers, insurance carriers, patients, and other stakeholders
• Assist in monitoring trends and elevate trends to supervisor to determine actions necessary to improve service outcomes
• Must have regular and predictable attendance and timely arrival at work Schedule
• Compliance with the provisions of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, as amended("HIPAA")

Required Qualifications:

• Bachelor's degree, in lieu of degree, 5 years of experience in Member Services or Provider Services, or Claims
• Prior experience in Member/Provider Prior Authorization/Appeal Services preferred
• Knowledge of medical terminology
• Knowledge of 3rd party payors, healthcare insurance and the prior authorizations process.
• Prioritize appropriately, and manage multiple tasks and job responsibilities
• Exceptional writing, editing and proofreading skills
• Strong verbal and written communication skills
• Strong organizational, analytical and problem-solving skills
• High motivation and the ability to work independently
• Working knowledge of MS Word, Excel, and Outlook
• Ability to preserve confidentiality of protected health information (PHI)
• Possess and maintain professional demeanor and courteous attitude

About Us:

For more than a decade, Asembia has been working with specialty pharmacies, manufacturers, prescribers, and other industry stakeholders to develop solutions for the high-touch specialty pharmaceutical service model.

Asembia focuses on the specialty pharmacy segment and offers comprehensive hub services, pharmacy network management, group purchasing (GPO) services, innovative technology platforms and more.

As a leading industry voice and advocate, Asembia is committed to bringing strategic channel management solutions, leading-edge products and high-touch services to the specialty pharmacy industry that help our customers optimize patient care and outcomes.

Asembia is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, gender identity and expression, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws.