Insurance Verification Specialist – Specialty Pharmacy
AssistRx
full-time
Posted on:
Location Type: Hybrid
Location: Maitland • Florida • United States
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Salary
💰 $19 - $22 per hour
About the role
- Help patients get access to the medications and therapies they need.
- Work directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and coverage.
- Support healthcare providers with questions regarding coding and billing, navigating complex reimbursement issues.
- Provide support for Prior Authorizations (PA) for an assigned caseload and assist with the appeals process to access medications.
- Ensure compliance with company requirements and defined standards.
- Conduct benefit investigations by making outbound calls to payers to verify patient insurance benefits.
- Document patient-specific benefits including coverage, cost share, and access/provider options.
- Identify coverage restrictions and expedite patient access where possible.
- Document and initiate the prior authorization process and claims appeals.
- Report reimbursement trends or delays to management.
- Act as a liaison for representatives, providers, and patients.
Requirements
- In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
- 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage
- 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements
- Excellent verbal communication skills and grammar
- Salesforce system experience preferred
Benefits
- Medical, dental, vision, life, & short-term disability insurance
- Teledoc services for those enrolled in medical insurance
- Supportive, progressive, fast-paced environment
- Competitive pay structure
- Matching 401(k) with immediate vesting
- Legal insurance
- 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary.
- $1,000 tenure vacation bonus upon 3-year anniversary and $2,500 upon 5-year anniversary.
- Quarterly and annual award programs recognizing employees' contributions and achievements.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
benefit investigationprior authorizationclaims appealscodingbillinginsurance coverage analysisreimbursement trends analysis
Soft Skills
verbal communicationinterpersonal skillsorganizational skills