Benefits Investigation Specialist

Sterling Specialty Pharmacy is part of Astrup Companies, an innovative, growing, family-owned business located in Mendota Heights, MN. We have a rich, 70 year history, with companies servicing every aspect of the pharmacy industry. As an employee of Sterling Specialty Pharmacy, you can expect to be treated with care and respect. We have a state of the art facility that was built in 2017 and are looking to continue to grow our strong team as our business grows.

• Looking for a Full-time (40 hours/week) candidate!
• Looking for Monday - Friday, 9:00am - 5:30pm shift availability.
• We offer Full health benefits, a 401(k) program with a company match and a Profit Sharing bonus program.
• This is a closed door pharmacy with no direct patient contact.
• We are a rapidly growing business with many opportunities for professional growth and advancement.

Qualifications:

• Required Education/Training/Professional Experience:

o High School Diploma or equivalent G.E.D required

o Knowledge of Microsoft Word, Excel; ability to work with multiple information systems

o Knowledge of medical and pharmaceutical terminology

• Preferred Education/Training/Professional Experience:

o Pharmacy experience preferred

Position Summary: The Benefit Investigation Specialist is responsible for performing the appropriate processes to verify patient eligibility and benefits. The Benefit Investigation Specialist will collect insurance information using multiple methods and sources, run test claims and complete administrative duties.

Core Competencies & Responsibilities:

• Determine if prior authorization of pre-cert is necessary and work accordingly
• Create verification note explaining benefits and other necessary information
• Document in patient record all activities and tasks pertinent to services rendered
• Process/reverse online claims as required
• Gather appropriate documentation, fill out necessary forms and submit authorization requests
• Process/reverse online claims as required
• Interpret AND resolve PBM rejections effectively
• Enter required authorization information into system(s)
• Collaborate with clinical staff to ensure appropriateness of the prior authorization documentation, and ensure completeness of the prior authorization questionnaires
• Escalate difficult verification issues when unable to resolve timely
• Support group and management efforts with a positive attitude
• Provide interdepartmental support as needed
• Troubleshoot prior authorization issues
• Understand how to refer patients to various assistance programs as needed based on patient’s insurance coverage, or lack thereof
• Seek and acquire financial assistance via foundation funds if patient states the need for assistance
• Understand insurance and insurance related coding to support claim processing
• Understand how to identify possible new contracting opportunities
• Understand how to request vacation/lost/damage overrides from the insurance carriers when warranted
• Communicate effectively, in person, over the phone and in writing
• Participate in quality program initiatives and improvement activities
• Work independently, as well as contribute to a team
• Maintain a flexible schedule that may include early morning, evening and weekend hours
• Manage large work volumes without loss of focus and with a high degree of accuracy
• Complete multiple daily work assignments and stay on schedule with all duties and responsibilities.
• Be dependable in attendance and motivated to demonstrate persistence and overcome obstacles
• Comply with all regulatory requirements, including HIPAA/HITECH
• Complete other responsibilities as assigned by Management

Performance Requirements:

• Possess a thorough knowledge of organizational policies, procedures, and systems
• Comply to all Astrup Companies policy and procedures
• Create a culture of positivity and excitement within the workplace
• Develop constructive and cooperative working relationships with other team members. Care. Respect their time, work and talents.
• Be able to multitask
• Be focused and disciplined
• Possess excellent organizational skills, with attention to detail and accuracy
• Be self-motivated and able to work well on an independent basis
• Display strong customer service skills
• Innovate - Think outside-the-box. Bring original ideas to the team/organization
• Embrace our Guiding Principles. Use them to guide decision making.
• Go Beyond!

Physical Requirements & Work Demands:

• Frequent immobility and/or sitting required for extended periods of time.
• Some bending and stooping required.
• Requires manual dexterity to operate keyboard, calculator, photocopy machine, and other office equipment.
• The ability to work 40 hours or more per week.
• The ability to maintain a flexible schedule when need arises

Working Environment:

• Normal call center, office environment

Job Type: Full-time

Pay: $19.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance

Work Location: In person

Salary : $19 - $23