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Investigation Specialist
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IT System Administrator
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Peer Support Specialist
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Application Support Engineer
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Police Communication Supervisor
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plasma center nurse, rn
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BioLife Plasma Services Pittsburgh, PA , USA, United StatesBy clicking the Apply button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda's Privacy Notice and Terms of Use . I further attest that all information I submi ...
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Junior Environmental Scientist
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Cash Applications Specialist
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SIU / Claims Investigator
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E-billing Specialist
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AML Analyst
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AML Analyst
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EH&S Specialist
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Program Specialist, Specialized Residential
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EH&S Specialist
3 weeks ago
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Benefit Investigation Specialist - Pittsburgh, United States - PSKW, LLC d/b/a ConnectiveRx
Description
Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications.
What you will do:
Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
Communicates case details to appropriate internal or external parties once benefit verification is complete
Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
Ability to effectively contribute alone or in small work groups
Effectively meets production and time completion goals
Accurately document payer Prior Authorization and Appeals protocols
Participate in special projects and perform additional duties as required
Maintain repository of payer or brand specific coverage information
Participate in training and process improvement initiatives
Minimum of 1) 2 years' experience in customer service, insurance, benefits, marketing, sales or related area, required, or 2) Bachelor's degree and 1-year of relevant experience
o
Health care environment with third party benefits verification experience preferred.
Understanding of commercial insurance concepts including coverage policies, major medical benefits, knowledge of government and patient assistance program, knowledge of and understanding of how to communicate information on health insurance, reimbursements, third party terms and medical terminology is preferred
Highly proficient computer skills.
Skill in managing email correspondence and personal documentation of research.
Focus on fundamental analytic and problem-solving skills.
Excellent time management skills
Strong professional customer services experience
High level of attention to detail
Be a critical thinker who is adaptable, and results driven.
High school diploma or equivalent, required. Bachelor's degree preferred
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