Description
Primary Role:
Insurance billing and prior authorizations specialists will provide direct and high-quality assistance to patients, prescribers, and pharmacies. They will diagnose, troubleshoot, and resolve barriers to medication access for patients of our health center clients.
Hybrid Role, 2-3 days in office per week.
Essential Job Functions
- Receiving new referrals via email, phone, electronic messaging on, and CoverMyMeds
- Calling pharmacies to identify the nature of insurance issues and gather patient insurance information
- Calling insurance plans or utilizing online formularies to find alternative covered drugs
- Communicating directly with nurses and doctors to field questions about patient medications and recommend alternative drugs when necessary for insurance coverage
- Utilizing the CoverMyMeds platform to submit prior authorizations
- Extracting relevant lab results and office notes from patient charts for use in prior authorization submission
- Documenting work performed and the outcomes of each referral case in internal application
- Following up with patients, doctors, and pharmacies to inform them of referral outcomes
EOE
Requirements
Required Education & Skills:
- Associate College Degree or higher / Minimum High School diploma or equivalent
- Ability to multitask and prioritize efficiently.
- Ability to take leadership direction to improve performance.
- Time management. Complete work within established time frames.
- Ability to work independently and be self-motivated.
- Excellent verbal communication skills
- Ability to report work orally or in writing to Supervisor, as applicable.
- Ability to establish and maintain cooperative, courteous working relationships with others.
- Ability to understand, apply and use personal computers and software applications.
- Ability to maintain confidentiality of company and client information.
Preferred Experience
- Experience in a healthcare setting (pharmacy, doctor’s office, or insurance company) is preferred.
- Working knowledge of the health care industry (Preferred)
Physical Requirements
Position is required to frequently stand, walk, sit, talk, hear, use of hands to type; must be able to read computer screen. Reasonable accommodations may be made to enable individuals with disabilities. May be subject to change based on business requirements and client needs.
