Senior Claims Specialist - Specialty Pharmacy

This role works directly with healthcare and pharmaceutical providers, as well as insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. You will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues.

• Single point of contact for questions and inquiries from the prescriber, patient, and field agent by territory.
• Identifies applicable programs and facilitates next steps.
• Holistically executes case management tasks and communicates the statuses of all patient support activities.
• Liaison with other program-specific Assist resources to secure outcomes for active patients.
• Accepts inbound calls for assigned territory or overflow of other territories and provides one call resolution support.
• Ensures protection is insured.
• Answers inbound calls and makes outbound calls to introduce services.
• Gathers patient data, addresses the needs of the patient and reviews insurance benefits.
• Records the call details in patient data system.
• Contacts insurers for verification of benefits.
• Handles difficult patient situations when they arise.
• Conducts follow-up with pharmacies.
• Performs other related duties as assigned by management.

Requirements

• QUALIFICATIONS:
• College degree is preferred or high school diploma; equivalent combination of education and experience is also considered.
• Other skills required: 
• Previous work experience in Medical and Pharmacy Reimbursement or Customer Service.
• Submitting billing data to appropriate insurance providers
• Processing claims and resolving denial instances.
• Achieving maximum reimbursement for services provided
• Completing Medicare, Medicaid and Commercial insurance claim submission.
• Documenting and reporting payment information.
• Professional level skills in computer use, including but not limited to Microsoft Office, email, 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

Why Choose AssistRx:

• Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary. Tenure vacation bonus: