This is a fully remote position, open to applicants in Illinois.

📋 Description

• Offer expert knowledge on medical and prescription insurance coverage, including verification, claim billing, medication prior authorization, appeal filing, and alternative financial assistance options.

• Precisely record information in the designated systems and formats.

• Relay referral status to physicians and patients through phone, fax, and/or the core pharmacy system.

• Support offices with prior authorization and appeal documentation and submission.

• Track authorization and appeal statuses to ensure swift processing and patient access to medication.

• Utilize internal and online tools to explore pharmacy and medical benefits.

• Collaborate with health insurance payers and providers while maintaining payer intelligence resources.

• Input patient demographic and health insurance data into the hub information system.

• Inform physicians of any incomplete or inaccurate insurance information.

⛳️ Requirements

• 1-3 years of experience in a healthcare or reimbursement environment.

• Required prior experience in a call center, healthcare office, corporate environment, healthcare insurance provider, or pharmacy.

• Comprehensive understanding of commercial and government pharmacy and medical insurance programs.

• Familiarity with billing, alternative funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations.

• Pharmacy call center experience is preferred for A+ candidates.

• Healthcare call center and medical claims experience is preferred for A- candidates.