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About the role
Key responsibilities & impact- Provide high quality customer service
- Effectively interface with patients, patient’s families, national payers, home cares and medical doctor’s offices to assist patient and medical provider in expediting
- Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices, and submit and obtain prior authorizations as required by payer
- Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval
- Accurately enter and maintain data as required in client database and patient files
- Utilize the client database to monitor outstanding items on each client case file
- Ensure files are complete so team can determine the current status
- Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases, drug orders and status of alternative funding
- Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient
- Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies
- May serve as single point of contact for an assigned group of prescribers
- Identify and report events as required by the REMS requirements for specified medication
- Recognize adverse event, product quality complaint, potential risk events, and forward information to the appropriate team member for reporting to the manufacturer
- Educate patients, prescribers, and others regarding program requirements, and facilitate referrals
- Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures
Requirements
What you’ll need- High School Diploma/GED or equivalent experience
- 4 – 6 years’ experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.
- Health Insurance claims or patient accounting experience a plus.
- Computer proficiency in MS Office applications, with database experience a plus.
- Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels.
- Ability to manage multiple priorities and meet deadlines.
- Detail oriented with good analytical skills.
- Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred.
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match*
- Tuition reimbursement
- Flexible work environment
- Discretionary PTO (Paid Time Off) OR 20 days PTO *note: JD should include one or the other.
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
benefit investigationsinsurance verificationprior authorizationsrecertificationdata entrythird party billingcodingmedical terminologyappeals
Soft Skills
customer servicecommunicationdetail orientedanalytical skillsability to manage multiple prioritiesability to meet deadlines
Certifications
High School DiplomaGED