Insurance Analyst II

24 hours ago


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

Job Summary:

We are seeking an experienced Insurance Analyst II to join our team at Spectraforce Technologies. As an Insurance Analyst II, you will be responsible for providing best-in-class customer service to patients, healthcare providers, and their staff through referral and call management. You will investigate patients' insurance benefits and financial assistance opportunities, process and monitor prior authorizations, and liaise between departments, payors, and providers to determine patients' overall prescription coverage.

Responsibilities:

  • Provide subject matter expertise on medical and prescription insurance coverage/verification, claim billing, medication prior authorization, and appeal filing.
  • Accurately document information in the appropriate systems and formats.
  • Communicate the status of referrals to physicians and patients via phone, fax, and/or the core pharmacy system.
  • Assist offices through the entire documentation and filing process for prior authorizations and appeals.
  • Monitor the status to ensure rapid turnaround and procurement of drug products for patients.
  • Use internal and web tools to 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 provide 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.
  • Determine whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy.
  • Participate in quality monitoring and identify and report quality issues.
  • Enter patient demographic and health insurance information into the hub information system and notify physicians of 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.
  • Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring client meets FDA regulations.
  • Complete all required training and perform all functions in the position.

Requirements:

  • Subject matter expertise on medical and prescription insurance coverage/verification, claim billing, medication prior authorization, and appeal filing.
  • Excellent communication and interpersonal skills.
  • Ability to work in a fast-paced environment and meet deadlines.
  • Strong analytical and problem-solving skills.
  • Ability to work collaboratively with other areas of the Pharmacy to maximize patients' access to care.

What We Offer:

We offer a competitive salary, comprehensive benefits package, and opportunities for professional growth and development. If you are a motivated and detail-oriented individual with a passion for delivering exceptional customer service, we encourage you to apply for this exciting opportunity.


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