Pharmacy Insurance Verification Specialist

RXinsider LTD.; Tampa, Northern (FL, KY); Hybrid; USD 26,000 - 28,000; Full time

Job summary

Rx relief in Tampa, FL is seeking a Pharmacy Insurance Verification Specialist to manage intake and onboarding for Workers' Compensation patients, gathering and validating all essential claim details for prompt prescription billing.

Acting as a central bridge between healthcare providers, insurance carriers, and internal teams, you will help prevent billing delays, ensure first-pass claim approvals, and minimize interruptions to patients receiving medications.

Qualifications

• 2+ years of professional experience in Workers' Compensation, pharmacy operations, medical billing, or health insurance verification.
• Solid understanding of Workers' Compensation claim lifecycles, pharmacy revenue cycles, and insurance verification workflows.
• Familiarity with medical terminology and pharmacy software platforms.
• Proven experience communicating with TPAs, insurance adjusters, employers, and medical offices.

Responsibilities

• Direct the initial intake process for all incoming Workers' Compensation patient accounts.
• Gather and verify accurate insurance, employment, and injury details needed to establish complete claim files.
• Communicate directly with insurance adjusters, TPAs, employers, physician offices, attorneys, and care managers to secure missing documentation.
• Review patient files and prescription data for accuracy and completeness prior to releasing claims for billing.
• Proactively research and resolve registration discrepancies or missing authorization info to minimize delay.
• Maintain precise, real-time records within the pharmacy management database.
• Partner with Billing, Collections, Prior Authorization, and Clinical operations teams to maintain a smooth patient intake workflow.
• Identify complex claim barriers and elevate them while adhering to HIPAA and data privacy guidelines.

Skills

Workers' Compensation

Pharmacy operations

Medical billing

Insurance verification

Education

High School Diploma or equivalent

Associate or Bachelor’s degree preferred

Tools

Microsoft Office Suite

Pharmacy software

Job description

Pharmacy Insurance Verification Specialist

Company: Rx relief

Location: Tampa, FL

Schedule: Full-Time | Monday – Friday

Position Overview

Rx relief is seeking a detail-oriented Pharmacy Insurance Verification Specialist to join our team in Tampa, FL. In this role, you will manage the intake and onboarding lifecycle for incoming Workers' Compensation patients. You will gather, validate, and process all essential claim details required for seamless initial prescription billing.

Acting as a central communication bridge between healthcare providers, injured workers, insurance carriers, claims adjusters, nurse case managers, and internal teams, you will play a vital role in preventing billing delays, maximizing first-pass claim approvals, and ensuring patients receive their medications without interruption.

Key Responsibilities

• Patient Onboarding: Direct the initial intake process for all incoming Workers' Compensation patient accounts.

• Claim Data Collection: Gather and verify accurate insurance, employment, and injury details needed to establish complete claim files.

• Stakeholder Coordination: Communicate directly with insurance adjusters, Third-Party Administrators (TPAs), employers, physician offices, attorneys, and care managers to secure missing documentation.

• Quality Assurance: Review patient files and prescription data for accuracy and completeness prior to releasing claims for billing.

• Problem Resolution: Proactively research and resolve registration discrepancies or missing authorization info to minimize delay.

• System Documentation: Maintain precise, real-time records within the pharmacy management database.

• Cross-Functional Collaboration: Partner closely with internal Billing, Collections, Prior Authorization, and Clinical operations teams to maintain a smooth patient intake workflow.

• Escalations & Compliance: Identify complex claim barriers and elevate them appropriately while strictly adhering to HIPAA and data privacy guidelines.

Qualifications & Requirements

Minimum Education

• High School Diploma or equivalent required.

• Associate or Bachelor’s degree preferred.

Experience

• 2+ years of professional experience in Workers' Compensation, pharmacy operations, medical billing, or health insurance verification.

• Solid understanding of Workers' Compensation claim lifecycles, pharmacy revenue cycles, and insurance verification workflows.

• Familiarity with medical terminology and pharmacy software platforms.

• Proven experience communicating with TPAs, insurance adjusters, employers, and medical offices.

Knowledge, Skills & Abilities

• Exceptional organizational skills with a strong focus on accuracy.

• Clear, professional written and verbal communication skills.

• Capability to manage multiple priorities and adapt quickly in a fast-paced environment.

• Proficient with Microsoft Office Suite and specialized healthcare/pharmacy software applications.

Physical Requirements

• Physical Demands: This position primarily involves stationary desk work, operating computer systems, and handling phone communications. Candidates should be able to sit or stand for extended periods, perform repetitive desk duties, and occasionally lift or move up to 25 lbs.

Compensation / Pay Rate (Up to): $19.00 - $20.00 Per Hour