Insurance Analyst I

1 day ago

Atlanta, Georgia, United States Spectraforce Technologies Inc Full time
Job Title: Insurance Analyst I

Spectraforce Technologies Inc is seeking a highly skilled Insurance Analyst I to join our team. As an Insurance Analyst I, you will be responsible for providing best-in-class customer services to patients, Health Care Providers (HCPs) and their staff through referral and call management by investigating patients' insurance benefits and financial assistance opportunities, in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy.

Key Responsibilities:
  • Provide subject matter expertise on medical and prescription insurance coverage/verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities.
  • Accurately document information in the appropriate systems and formats.
  • Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.
  • Assist offices through the entire documentation and filing process for prior authorizations and appeals.
  • Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient. Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits.
  • Obtain and confirm information to maintain Pharmacy Solutions' payor intelligence resources.
  • Meet or exceed department standards relative to performance metrics.
  • Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics.
  • Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.
  • Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review, guidance, and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
  • Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information
  • Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and client.
  • Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring client meets FDA regulations.
  • Completes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews.
  • Perform additional tasks, activities, and projects as deemed necessary by management.

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