Description : Purpose :

Purpose :

Describe the primary goals objectives or functions or outputs of this position.

The primary function of the Insurance Analyst I is to provides best-in-class customer services to patients Health Care Providers HCPs and their staff through referral and call management by investigating patients insurance benefits and financial assistance opportunities in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy.

This position will be a subject matter expert in insurance billing claims processing and prior authorizations. This position liaises between departments payors and providers to comprehensively determine patients overall prescription coverage.

The Insurance Analyst I handles patient requests received by phone or electronically fax Humira Complete Pro or other systems and would complete related outbound calls.

This position works collaboratively with other areas of the Pharmacy to maximize patients access to care.

Must have access to a secure and private location to work from daily.

Responsibilities :

List up to 10 main responsibilities for the job. Include information about the accountability and scope.

Provide subject matter expertise on medical and prescription insurance coverage / verification claim billing medication prior authorization and appeal filing and alternate financial assistance opportunities.

Accurately documents information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone fax and / or the core pharmacy system as per established policies and procedures.

• Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.
• Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits.

Obtain and confirm information to maintain Pharmacy Solutions payor intelligence resources.

Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics.

Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and / or resolve situations taking ownership as needed.

Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues / concerns to management for review guidance and resolution.

Participate in quality monitoring and in identifying and reporting quality issues.

• Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information
• Understand and comply with all required training including adherence to federal state and local pharmacy laws HIPAA policies and guidelines and the policies and procedures of Pharmacy Solutions and AbbVie.
• Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.
• Completes all required training and performs all functions in the position Soft Skills certification product and disease overviews.

Perform additional tasks activities and projects as deemed necessary by management.

Qualifications :

List required and preferred qualifications up to 10. Include education skills and experience.

• High school diploma or GED equivalent required. Degree preferred.
• 1-3 years of work experience in a healthcare or reimbursement setting call center preferred. Previous experience in a call center environment healthcare office corporate setting or healthcare insurance provider or pharmacy is highly desirable.
• Must have thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs billing alternate funding resources reimbursement processes prior authorization and appeal filings and specialty pharmacy operations.
• Demonstrated ability to lead and participate within a team manage multiple priorities and meet associated timelines while maintaining accuracy.
• Demonstrated strong accurate technical skills. Must be detail oriented. Professional written and verbal communication skills required.

Ability to maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.

• Proven organizational and problem solving skills elevating to management when appropriate.
• Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.

Must have access to a secure and private location to work from daily.

Skills :

insurance verification, call center, inbound call, outbound calls, claims follow up

Top Skills Details :

Additional Skills & Qualifications :

5 Years of Insurance Verification / Prior Authorization Experience (50 Daily) (REQUIRED)

Claims resolution experience from start to end - must know how to work denials (REQUIRED)

3 Years of recent Call Center Experience; 50 Calls per day w / tracked KPI's (REQUIRED)

Proven tenure at previous positions

Experience Level : Entry Level

Entry Level

About TEKsystems :

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity.

We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia.

As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.

That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Last updated : 2024-05-16