Claims Resolution Specialist

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
  
  

“Nuvem provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, creed, religion, sex, gender, gender identity, gender expression, national origin, ancestry, age, physical or medical disability, medical condition, marital status, sexual orientation, military and/or veteran status, or any other basis prohibited by applicable state or federal law.”

Requirements

Required Education & Skills:

• Associate College Degree or higher / Minimum High School diploma or equivalent
• Must have 3-4 years of previous pharmacy technician and or claims insurance exp.
• 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.