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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in customer service and reimbursement processes within the insurance and pharmaceutical industries, with strong capabilities in benefit investigations, prior authorizations, and data management.
Highest-signal resume keywords
Customer ServiceBenefit InvestigationsPrior AuthorizationsThird Party BillingMedical Terminology
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance ClaimsPatient AccountingData EntryAnalytical SkillsDetail Oriented
Soft Skills
Excellent Communication SkillsAbility to Manage Multiple Priorities
Tools & Technologies
MS Office ApplicationsClient Database
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
BiotechnologyPharmaceuticalReimbursementCodingAppeals
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
- Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices
- 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
- 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
- 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.
- Ability to travel as required - This is primarily a remote position; however, occasional travel may be required based on client, business, or training needs.
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match*
- Tuition reimbursement
- Flexible work environment
- 20 days PTO
- 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