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Insurance Reimbursement Specialist

3 months ago

Tempe, United States Birdi, Inc. Full time
Job DescriptionJob Description

Job Title: Insurance Reimbursement Specialist Department: Specialty

Reports to: Supervisory Specialty Ops Effective Date: January 2024

Job Summary:

The Insurance Reimbursement Specialist will work as a member of the Specialty by Birdi team by utilizing various business applications to perform analysis, obtain information, and enter data necessary for prescription processing and claims adjudication within the standards for accuracy, timeliness, productivity, and client performance commitments. This role will focus on facilitating the Prior Authorization process between and with Providers and Payers/PBMs as well as exploring and obtaining funding to assist in patients out of pocket expenses.

Duties/Responsibilities:

  • Assists Providers with the facilitation of the Prior Authorization process.
  • Leads Benefit Investigations regarding claim submissions through research and outbound calling to Patient, Providers, and Insurance Companies.
  • Provides research on funding programs and assists patients with obtaining affordable care on their medications.
  • Performs a variety of operational tasks across various systems for a moderately complex-to- complex process or functions.
  • Resolve issues that require prescription entry, correction, and/or replacement due to a reported quality, shipping, and/or claim submission concern.
  • Performs other related duties as assigned.

Required Skills/Abilities:

  • Proficient with Microsoft Office Suite or related software.
  • Excellent verbal and written communication skills.
  • Excellent interpersonal and customer service skills.
  • Excellent organizational skills and attention to detail.
  • Excellent time management skills with a proven ability to meet deadlines, prioritize work and work independently.
  • Strong analytical and problem-solving skills.
  • Ability to function well in a high-paced and at times stressful environment.

Education and Experience:

  • High School Diploma required, Undergraduate degree desired or equivalent work experience.
  • At least 2+ years in Pharmacy setting. Prior experience in Retail, Mail Order of Specialty Pharmacy, PBM, pharmaceutical or managed health care industry preferred.
  • Current Pharmacy Technician with National Certification and state licensing required.

Physical Requirements:

  • Prolonged periods of sitting, standing, walking, and working on a computer.
  • Ability to bend, reach, stoop, kneel.
  • Must be able to lift up to 15 pounds at times.