Insurance Verification Specialist
3 weeks ago
Although this position is remote, the person must reside in Pennsylvania.
Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or third-party providers about the company’s products or services following standard SOPs and procedures, working under direct supervision. Ensures all contacts receive efficient and courteous service.
Job ResponsibilitiesRespond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concerns.Requests and loads PBM and/or Major Medical insurance plans.Processes all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.Assists physicians in the prior authorization process including initiation of prior authorizations.May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.Verifies benefits for Major Medical via online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose best solutions and resolves customer and plan covers.Facilitates the reimbursement windshields for PBM major medical claims.Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.Manages Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal support.May administer order queue such as Submission Problems or Waiting for Payment.Documents contact interactions, records details, complaints, comments, and actions taken.About Walgreens and WBA
Walgreens (www.walgreens.com) is included in the U.S. Retail Pharmacy and U.S. Healthcare segments of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), an integrated healthcare, pharmacy and retail leader with a 170-year heritage of caring for communities. WBA’s purpose is to create more joyful lives through better health. Operating nearly 9,000 retail locations across America, Puerto Rico and the U.S. Virgin Islands, Walgreens is proud to be a neighborhood health destination serving nearly 10 million customers each day. Walgreens pharmacists play a critical role in the U.S. healthcare system by providing a wide range of pharmacy and healthcare services, including those that drive equitable access to care for the nation’s medically underserved populations. To best meet the needs of customers and patients, Walgreens offers a true omnichannel experience, with fully integrated physical and digital platforms supported by the latest technology to deliver high-quality products and services in communities nationwide.
The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please visit jobs.walgreens.com/benefits.
'An Equal Opportunity Employer, including disability/veterans'.
High school diploma/GEDExperience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industryAbility to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential mannerBasic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents and/or access information on-line).
-
Data Verification Specialist
2 days ago
Pittsburgh, United States Oxford Solutions Full timeJob DescriptionJob DescriptionOpening with our client for a Data Verification Specialist.Our client is seeking a meticulous and detail-oriented Data Verification Specialist to join their team. In this role, you will be responsible for ensuring the accuracy and completeness of data by utilizing various tools and resources.Responsibilities:Utilize FileZilla...
-
Data Verification Specialist
3 hours ago
Pittsburgh, United States Oxford Solutions Full timeJob DescriptionJob DescriptionOpening with our client for a Data Verification Specialist.Our client is seeking a meticulous and detail-oriented Data Verification Specialist to join their team. In this role, you will be responsible for ensuring the accuracy and completeness of data by utilizing various tools and resources.Responsibilities:Utilize FileZilla...
-
Insurance Verification Specialist
2 weeks ago
Pittsburgh, United States Blink Health Full timeCompany Overview: Blink Health is a healthcare technology company that builds products to make prescriptions accessible and affordable to everybody. Our two primary products - BlinkRx and Quick Save - remove traditional roadblocks within the current prescription supply chain, resulting in better access to critical medications and improved health outcomes for...
-
Billing Specialist
1 week ago
Pittsburgh, United States North Pittsburgh Oral Surgery Full timeJob Description Job Description Description: Job Summary The Billing Specialist is responsible for the practice's financial intake, striving for accuracy in every aspect of dental and medical billing. Essential Functions/Responsibilities: All shall be performed in accordance with OSHA, DEA, HIPAA, and NPOS guidelines and expectations. Working directly with...
-
Billing Specialist
1 month ago
Pittsburgh, United States North Pittsburgh Oral Surgery Full timeJob DescriptionJob DescriptionDescription:Job SummaryThe Billing Specialist is responsible for the practice's financial intake, striving for accuracy in every aspect of dental and medical billing.Essential Functions/Responsibilities:All shall be performed in accordance with OSHA, DEA, HIPAA, and NPOS guidelines and expectations.Working directly with the...
-
Insurance & Follow-up Specialist II
5 days ago
Pittsburgh, United States Riverside Health System Full timeNewport News, Virginia Overview The Insurance and Follow-Up Specialist II provides timely follow-up of facility claims for all acute care based locations. Manages assigned portion of AR and aging reports and responds to insurance company requests for information and works to identify issues. Assists with coaching and training staff. What you will do ...
-
Senior Payroll Specialist
7 days ago
Pittsburgh, United States Creative Financial Staffing Full timeSENIOR PAYROLL SPECIALIST ABOUT THE COMPANY: Work for the largest food processing company in Kern County Be apart of a great payroll team that is team oriented Company loves to provide products and swag to their employees Opportunity for advancement Supportive leadership team Fully on-site OVERVIEW OF THE SENIOR PAYROLL SPECIALIST ROLE: Oversee the...
-
Senior Payroll Specialist
1 week ago
Pittsburgh, United States Creative Financial Staffing Full timeSENIOR PAYROLL SPECIALIST ABOUT THE COMPANY: Work for the largest food processing company in Kern County Be apart of a great payroll team that is team oriented Company loves to provide products and swag to their employees Opportunity for advancement Supportive leadership team Fully on-site OVERVIEW OF THE SENIOR PAYROLL SPECIALIST ROLE: Oversee the...
-
Patient Support Specialist
2 weeks ago
Pittsburgh, United States ConnectiveRx Full timeThe primary purpose of this position is to engage in and maintain regular communication with physicians, medical office staff, outside sales representatives, and internal medical staff to support, document, and coordinate patient hub services. This communication will routinely be in the form of inbound phone calls, issue ticket management, and live chat....
-
Closing Specialist
4 days ago
Pittsburgh, United States Ultimate Staffing Full timeClosing Specialist - Direct Hire Ultimate Staffing is partnered with a well-established title and settlement company in the Pittsburg area that has an immediate opening for an experienced Closing Specialist to join their team. Direct hire opportunity. On-site required.Hours: Monday - Friday 8 AM to 5 PM with required flexibility.Salary - 55,000 per yearGreat...
-
Closing Specialist
3 days ago
Pittsburgh, United States Ultimate Staffing Full timeClosing Specialist - Direct Hire Ultimate Staffing is partnered with a well-established title and settlement company in the Pittsburg area that has an immediate opening for an experienced Closing Specialist to join their team. Direct hire opportunity. On-site required. Hours: Monday - Friday 8 AM to 5 PM with required flexibility. Salary - 55,000 per year...
-
Housing Specialist
3 days ago
Pittsburgh, United States Urban League of Greater Pittsburgh, Inc. Full timeJob DescriptionJob DescriptionDescription:Compensation Range: $18.13/hourFLSA Status: NonexemptWork Location: Warner Centre, Fourth Floor, 332 Fifth Avenue, Pittsburgh, PA 15222Schedule: 9:00 am to 5:00 pm Monday through Friday, weekends and evenings as neededTravel Required: Some travel may be requiredBenefits Summary: Paid holidays, medical insurance,...
-
Billing Specialist
1 day ago
Pittsburgh, United States Tech24 Full timeBilling Specialist. FM, Facilities Management, a Tech24 company. Contact Brad at -- The Billing Administrator provides financial and administrative duties to ensure accuracy and efficiency of operations. This is a fast-paced position and would be suitable for an individual who has experience in billing and/or clerical work. Experience with Quickbooks...
-
Benefit Investigation Specialist
1 month ago
Pittsburgh, United States ConnectiveRx Full timeResponsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications. Maintains high quality customer service standards in compliance with federal and state regulations and guidelines. What you will do: * Makes outbound calls to Payers and...
-
Intake Specialist 1pm-9:30pm M-F
5 days ago
Pittsburgh, United States ZOLL Services LLC (on SAM site) Full timeReference #: R9340 CMS The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies. Heart disease is the leading cause of death for both men and women in the U.S. At...
-
Intake Specialist 1pm-9:30pm M-F
5 days ago
Pittsburgh, United States ZOLL Medical Full timeCMS The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies. Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will...
-
Intake Specialist 1pm-9:30pm M-F
5 days ago
Pittsburgh, Pennsylvania, United States tapwage Full timeCMSThe Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help...
-
Pittsburgh, United States Anova Health Care Services, Inc. - Pittsburgh Full timeJob DescriptionJob DescriptionDescription:Anova Health Care Services, Inc. is a trusted and innovative in-home care company, providing high-quality, customized, professional caregiving services to those who are aging and need assistance to live independently, are managing chronic health issues, are recovering from a medical setback, or have special needs or...
-
Pittsburgh, United States FTSI Inc Full timeThe HRIS Specialist plays a pivotal role in optimizing human resource systems and processes while leading implementations and partnering with key stakeholders. This role HR systems will drive new processes and enhancements to support talent acquisition, talent management, and learning within a global Human Capital Management (HCM) system. Continuously...
-
Fulfillment Specialist
4 days ago
Pittsburgh, United States Fastenal Full timeReference #: 563202 Job Description Fulfillment Specialist 621 Napor Blvd, Pittsburgh, PA 15205 PAPI1 Public Store Part-time Shift(s): MON TUE WED THU FRI 7:00am - 5:00pm 20 - 28 hours/week OVERVIEW: Embark on your journey as a Part-time Fulfillment Specialist, where you'll take charge of delivering excellence by replenishing inventory solutions and...