at Teksystems in Chicago, Illinois, United States
Job Description
Description:
The primary function of this role is to work with patients, Health Care Providers (HCPs) and their staff through referral and 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 or medication.
An Insurance Analyst is a subject matter expert in insurance billing, claims processing, and prior authorizations. Agent will work between departments, payors and providers to comprehensively determine patients’ overall prescription coverage. Handles patient requests received by phone or electronically (fax, Humira Complete Pro, or other systems).
Responsibilities:
-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.
-Use internal and web tools to 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.
-Accurately document and complete the 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.
-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.
- 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.
- Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information
- Call volume varies. Between 10-30 outbound and inbound calls in a given day
Work Enviornment:
Remote Position: Candidate must have a private work space at a residential address. Any changes in work location must be pre-approved. Training will take 9-10 weeks, no time off allowed during this training period. During training, agent will work 8am-4:30pm. After training, agent will be randomly assigned an 8-hour shift between the hours of 7am-7pm Central Time. No request for a specific schedule is allowed. Potential shifts are: 7am-3:30pm 8am-4:30pm 8:30am-5:00pm 9:30am-6pm 10:30am-7pmSkills & Qualifications:
- 2-5 years of work experience in a healthcare or reimbursement setting. Previous experience in a healthcare office, corporate setting, 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. -Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.-High school diploma or GED equivalent required. Degree preferred.
-Demonstrated ability to lead and participate within a team, manage multiple priorities and meet associated timelines while maintaining accuracy.
-Computer literate, experienced dealing with tough conversations, candidates need to be comfortable having difficult calls with patients, commercial/gov’t insurance knowledge, patient centric.
-Experience working patients, medical office setting, knowledge of prescription/medical insurance.
-EMR experience
-Proven organizational and problem-solving skills, elevating to management when appropriate.
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.
