Pharmacy Insurance Verification Specialist
Company: Rx relief
Location: Tampa, FL
Schedule: Full-Time | Monday – Friday
Position Overview
Rx relief is seeking a detail-oriented Pharmacy Insurance Verification Specialist to join our team in Tampa, FL. In this role, you will manage the intake and onboarding lifecycle for incoming Workers' Compensation patients. You will gather, validate, and process all essential claim details required for seamless initial prescription billing.
Acting as a central communication bridge between healthcare providers, injured workers, insurance carriers, claims adjusters, nurse case managers, and internal teams, you will play a vital role in preventing billing delays, maximizing first-pass claim approvals, and ensuring patients receive their medications without interruption.
Key Responsibilities
Patient Onboarding: Direct the initial intake process for all incoming Workers' Compensation patient accounts.
Claim Data Collection: Gather and verify accurate insurance, employment, and injury details needed to establish complete claim files.
Stakeholder Coordination: Communicate directly with insurance adjusters, Third-Party Administrators (TPAs), employers, physician offices, attorneys, and care managers to secure missing documentation.
Quality Assurance: Review patient files and prescription data for accuracy and completeness prior to releasing claims for billing.
Problem Resolution: Proactively research and resolve registration discrepancies or missing authorization info to minimize delay.
System Documentation: Maintain precise, real-time records within the pharmacy management database.
Cross-Functional Collaboration: Partner closely with internal Billing, Collections, Prior Authorization, and Clinical operations teams to maintain a smooth patient intake workflow.
Escalations & Compliance: Identify complex claim barriers and escalate them appropriately while strictly adhering to HIPAA and data privacy guidelines.
Qualifications & Requirements
Minimum Education
Experience
2+ years of professional experience in Workers' Compensation, pharmacy operations, medical billing, or health insurance verification.
Solid understanding of Workers' Compensation claim lifecycles, pharmacy revenue cycles, and insurance verification workflows.
Familiarity with medical terminology and pharmacy software platforms.
Proven experience communicating with TPAs, insurance adjusters, employers, and medical offices.
Knowledge, Skills & Abilities
Exceptional organizational skills with a strong focus on accuracy.
Clear, professional written and verbal communication skills.
Capability to manage multiple priorities and adapt quickly in a fast-paced environment.
Proficient with Microsoft Office Suite and specialized healthcare/pharmacy software applications.
Physical Requirements
Physical Demands: This position primarily involves stationary desk work, operating computer systems, and handling phone communications. Candidates should be able to sit or stand for extended periods, perform repetitive desk duties, and occasionally lift or move up to 25 lbs.
Compensation / Pay Rate (Up to): $19.00 - $20.00 Per Hour
