Associate Director, Medical Affairs
Apellis Pharmaceuticals
Insurance Verification Specialist
AssistRx
full-time
Posted on:
Origin: • 🇺🇸 United States • Arizona
Visit company websiteSalary
💰 $20 - $23 per hour
Job Level
Mid-LevelSenior
About the role
- Gather information about a patient’s insurance and coverage for a specific pharmaceutical product
- Support healthcare providers with coding, billing, and navigating complex reimbursement issues
- Provide support for Prior Authorizations (PA) for an assigned caseload and navigate the appeals process to access medications
- Ensure cases move through the process in compliance with company requirements and defined standards
- Conduct benefit investigations by making outbound phone calls to payers to verify patient insurance benefit information
- Verify patient-specific benefits and document coverage, cost share, and access/provider options
- Identify coverage restrictions and details to expedite patient access
- Document and initiate prior authorization processes and claims appeals
- Report reimbursement trends or delays in coverage to management
Requirements
- In-depth understanding and experience with Buy & Bill, Major Medical & Pharmacy Benefit Coverage
- 2 to 5 years of benefit investigation involving the analysis and interpretation of insurance coverage
- 3 to 5 years of experience interacting with healthcare providers in regard to health insurance plan requirements
- Excellent verbal communication skills and grammar
- Computer literacy/competence
- Salesforce system experience preferred
- Pre-employment background check required
- Must verify identity and eligibility to work in the United States; sponsorship/work authorization not available
