Insurance Claims Specialist

2 days ago

Robinson, Illinois, United States Medix™ Full time
Insurance Verification Specialist

We are seeking a dedicated Insurance Verification Specialist to improve patient care and contribute to our team's success.

Key Responsibilities:

  • Pharmacy Claims Processing: Accurately and timely process pharmacy claims to meet client expectations.
  • Claims Triaging: Analyze and triage rejected pharmacy insurance claims to determine patient coverage.
  • Prior Authorization Requests: Assist in initiating new prior authorization requests with providers and identify the correct forms needed based on patient insurance.
  • Coordination with Providers: Collaborate with prescribers and medical offices to ensure all necessary information is accurately provided on prior authorization forms.
  • Status Follow-Up: Regularly follow up with medical offices to check the status of prior authorization requests and communicate updates to patients and providers.
  • Appeals Management: Work with medical offices to handle appeals as needed.
  • Interdepartmental Support: Address internal inquiries related to prior authorization requests.
  • Compliance Maintenance: Ensure compliance with patient assistance program guidelines and document all findings according to operating procedures.
  • Research & Confidentiality: Conduct necessary research using available resources while maintaining the confidentiality of patient and proprietary information.

Requirements:

  • Education: High school diploma or GED required; Bachelor's degree preferred.
  • Experience: Minimum one year of healthcare experience, preferably in pharmacy, resolving third-party claims.
  • Skills:
    • Strong verbal and written communication skills.
    • Technical proficiency and analytical ability.
    • Excellent judgment and operational focus.
    • A commitment to providing exceptional patient care.
    • Ability to work collaboratively with peers and across departments.
    • Strong aptitude for learning complex software systems.

Work Schedule:

Hours: Monday - Friday: 8:00 AM - 9:30 PM, Saturday: 9:00 AM - 5:00 PM. (40 Hours a week)

  • Flexibility Required: During Q4, candidates must be flexible to work an 8-hour shift within the operating hours. One Saturday a month is expected, with a midweek day off scheduled in return. Schedules will be provided with approximately two weeks' notice.

We are particularly interested in candidates with experience in:

Pharmacy Business Office / Pharmacy Technician roles

Physician Office or Hospital - RCM/Business Office/Front Desk

Centralized Scheduling or Intake for healthcare organizations

Claims processing or related health plan backgrounds

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