Pharmacy Claims Representative

at Teksystems in Chicago, Illinois, United States

Job Description

Description:

-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.

- Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information

Qualifications:

-High school diploma or GED equivalent required. Degree preferred.

-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.

Relevant call center experience working with medical claims/authorizations (including appeals and denials) is required – *Will be answering inbound calls and placing outbound calls in these roles – must be comfortable being on the phone*

Hours:

Must be available for shifts between 7AM – 7PM EST Monday – Friday.

This is a fully remote long term contract role starting August 19th.

Compensation determined on location, tenure, and experience relevance.

1-2 years – 16-20hr

3+ years – 20 – 25hr

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.