Medical CoPay Claims Processor

DUTIES AND RESPONSIBILITIES:

• Processes medical copay claims in accordance with program business rules.
• Liaison with other program-specific AssistRx resources to secure outcomes for active patients.
• Performs outbound calls to inform and collect missing information.
• Ensures accuracy with attention to detail for copay claim processing and additional data collection.
• Performs other related duties as assigned by management.
• Perform daily reconciliation of batch postings, including automated/manual claim inputs.
• Analyze claims for accuracy based on insurance coverage, cost of goods, allowable amounts, and copays.
• Troubleshoot rejected claims and process prior authorizations or overrides.
• Maintain working knowledge of prescription plans and billing policies to ensure compliance and reimbursement.
• Monitor profitability of orders, manage claim queues (e.g., 3 & 5, 541, B queues), and adjust last events accordingly.
• Ensure timely claim submissions and adherence to adjudication and delivery windows.
• Coordinate with the Financial Assistance Department for additional funding when necessary.
• Promptly report reimbursement changes, underpayments, pricing discrepancies, or cost assistance needs.

Requirements

• College degree is preferred or a high school diploma with equivalent combination of education and experience.
• Other skills required: 
• Previous work experience in Medical Reimbursement including HICF forms and EOBs.
• Comprehensive understanding of Explanation of Benefits and application of patient benefit including HCPCs level II and CPT codes.
• Processing claims and resolving denial instances
• Calculate patient responsibilities for copay reimbursement for services provided as outlined within the program business rules.
• Strong understanding of Government benefits such as Medicare, Medicaid, and Tricare.
• Documenting and reporting payment information.
• Professional level skills in computer use, including but not limited to Microsoft Office Suite, web-based applications, and keyboard skills.
• Demonstrated strong written and verbal communication skills with providers, patients and insurance companies.
• Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics.
• Problem solving skills.

COMPETENCIES:

• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.

• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values

Benefits

• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive cons