Senior Insurance Resolution Lead — Hybrid/Remote

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

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.