Responsibilities
• Analyze benefits inquiries for high-cost medications on insurance platforms.
• Verify patient eligibility for medication coverage through insurance.
• Initiate and manage the prior authorization process when necessary.
• Communicate with healthcare providers and insurance companies to secure authorizations.
• Verify claims eligibility and ensure accurate claims processing.
• Investigate and resolve discrepancies or denials related to medication claims.
• Estimate medication costs based on insurance coverage and benefits.
• Provide cost information to patients and healthcare providers for informed decision-making.
• Maintain accurate records and documentation for compliance and future reference.
• Ensure compliance with healthcare regulations, policies, and procedures.
• Demonstrate exceptional attention to detail to ensure accuracy in all tasks.
Qualifications and Requirements
• Strong knowledge of pharmacy benefit plans, prior authorization processes, and claims eligibility.
• Proficient in using insurance platforms and prior authorization system.
• Meticulous attention to detail and the ability to manage complex information.
• Clear and coherent in both written and verbal communication skills with the ability to communicate effectively with patients, providers, and insurance representatives.
• Ability to work under pressure and handle multiple tasks simultaneously in a fast-paced environment.
• Knowledge of HIPAA and compliance regulations.
• Ability to work both independently and as part of a team.
