Asembia is seeking a
Medical Benefits Specialist for our organization. Our teams are comprised of passionate and motivated professionals; and through collaborative programs, contracting initiatives, patient support hub services and innovative technology platforms, Asembia is committed to positively impacting the patient journey. We offer our employees the latitude required for professional growth and career advancement.
Regular work shifts may vary: The Pharmacies operating hours are 8:00 am – 11:00 pm EST Monday through Friday, and Saturday through Sunday 8:00 am - 8:00 pm EST. At our discretion five 8-hour shifts will be assigned during any of the pharmacy operating hours.
The incumbent is responsible for executing program requirements, managing daily workflow, providing accurate and complete data input, managing pre-certifications and providing high levels of customer service.
Job Scope And Major Responsibilities
- Effectively perform in a high-volume call center hub requiring a blend of soft skills (patience, empathy/compassion, active listening, problem solving) and technical/process skills (mastery of tools, knowledge base, adherence to SOPs, efficient multitasking, problem-solving) to handle numerous calls quickly and accurately, use available resources like knowledge bases, and maintain quality through focused communication and efficient workflow, ensuring quick resolutions while balancing speed with customer satisfaction.
- Educating clients and their healthcare team on the components of their insurance coverage, including Medical and Prescription benefits.
- Research billing issues and contact insurance carriers to resolve claim issues
- Advocating for patients/clients in the prior authorization process, including denials and appeals.
- Manage time sensitive task completion on referral and prior authorization submissions
- Ability to interact professionally with not only internal matrix partners, but external contacts such as providers, insurance carriers, patients, and other stakeholders
- Assist in monitoring trends and escalate trends to supervisor to determine actions necessary to improve service outcomes
- Adheres at all times to physical, administrative and technical safeguards related to core business when executing job functions.
- Regular attendance and schedule adherence is critical.
- Adhering to company policies and procedures.
- Possess a professional demeanor, focused on respectful communication, a positive and reliable attitude, and responsible behavior. This includes dressing appropriately, being punctual, maintaining composure, and demonstrating accountability for your actions.
- Working outside of core business hours may be required.
- Other duties as assigned.
- Some travel may be required.
- Compliance with the provisions of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, as amended (“HIPAA”).
Performance Criteria
Performance in this role is measured by accurate and timely routing of referrals and reporting as well as high levels of customer service.
Required Minimum Qualifications
New Jersey Office ONLY:
- Must be registered with the State of New Jersey Board of Pharmacy as a Pharmacy Technician.
- Must successfully complete the ASPN Pharmacies New Jersey Policies and Procedures: Assessment.
Nevada Office ONLY
- Must have Nevada Pharmacy Technician License. Technician Trainee License, issued by the Nevada State Board of Pharmacy is permitted only for internal candidates striving to obtain their Nevada Pharmacy Technician license.
Arizona Office ONLY
- Pharmacy Technician License (requires national certification by PTCB or ExCPT), or Technician Trainee License, issued by the Arizona State Board of Pharmacy.
Pennsylvania Office ONLY
- Must have Pennsylvania Pharmacy Technician License.
Remote Workers
- Must be registered as a Pharmacy Technician with both their home state Board of Pharmacy and the Board of Pharmacy in the state where their assigned office is located.
ALL LOCATIONS:
- High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare or a related field preferred.
- Five years of experience in Member Services, Provider Services, or Claims required; prior authorization, appeals, specialty pharmacy, or patient assistance program experience preferred.
- Knowledge of medical terminology, third-party payors, healthcare insurance, and prior authorization processes.
- Strong written, verbal, editing, proofreading, organizational, analytical, and problem-solving skills.
- Ability to prioritize, manage multiple responsibilities, work independently, and maintain motivation in a fast-paced environment.
- Working knowledge of Microsoft Word, Excel, and Outlook.
- Ability to maintain confidentiality of protected health information (PHI) and demonstrate a professional, courteous demeanor.
- Possess and maintain professional demeanor and courteous attitude at all levels.
- Reliable and consistent attendance and schedule adherence is required.
Join our team! If you feel you are the right fit for this role, please apply. We look forward to speaking with you further about working with Asembia.
About Us
For more than a decade, Asembia has been working with specialty pharmacies, manufacturers, prescribers, and other industry stakeholders to develop solutions for the high-touch specialty pharmaceutical service model.
Asembia focuses on the specialty pharmacy segment and offers comprehensive hub services, pharmacy network management, group purchasing (GPO) services, innovative technology platforms and more.
As a leading industry voice and advocate, Asembia is committed to bringing strategic channel management solutions, leading-edge products and high-touch services to the specialty pharmacy industry that help our customers optimize patient care and outcomes.
Asembia is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, gender identity and expression, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws.
