Job Title: Benefits Verification Coordinator/Insurance Verification Specialist

Job Description

Provide high quality customer service to patients and prescribers while protecting patient confidentiality. Verify information on prescriptions received prior to processing (correct prescriber, name of patient, patient information, medication, dose, quantity, number of refills). Effectively use our internal pharmacy management software, PrimeRx, to complete claims processing and prior authorizations. Perform patient level benefits verifications as applicable for all pharmacy benefits plans. Complete prior authorization templates per payer requirements to ensure medication orders will be covered by insurance plans. Evaluate all completed prior authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations. Process prior authorization responses via CoverMyMeds and submit appeals if requested by patient/prescriber. Communicate as necessary with patients to determine general health status, medication compliance, medication and supply inventory, and overall coordination of care and service (custom assessment in software system) as applicable. Make outbound calls to prescribers, patients, and insurance companies. Assist with inbound calls as needed for respective program(s). Perform follow up on all outstanding prior authorizations/orders while following program specific correspondence for patient/prescriber/insurance. Adhere to program specific rules and timelines when processing orders. Prepare and maintain patient profile, medication administration records, and other documents as needed when setting up orders for shipment.

Responsibilities

• Coordinate and process patient medication orders, including order intake within regulatory boundaries.
• Provide customer service coordination and perform pharmacy technician duties as defined by policy and regulation.
• Verify information on prescriptions received prior to processing.
• Use internal pharmacy management software, PrimeRx, to complete claims processing and prior authorizations.
• Perform patient level benefits verifications for all pharmacy benefits plans.
• Complete prior authorization templates per payer requirements.
• Evaluate completed prior authorizations to ensure appropriate information for reimbursement and compliance.
• Process prior authorization responses via CoverMyMeds and submit appeals if requested.
• Communicate with patients to determine health status, medication compliance, and supply inventory.
• Make outbound calls to prescribers, patients, and insurance companies.
• Assist with inbound calls for respective program(s).
• Follow up on all outstanding prior authorizations/orders while adhering to program specific correspondence.
• Adhere to program specific rules and timelines when processing orders.
• Prepare and maintain patient profiles and medication administration records.

Essential Skills

• High School diploma or equivalent.
• Experience in insurance verification, medical billing, and prior authorization.
• Proficiency in data entry and call center customer service.
• Coordination of benefits and inbound call handling.

Additional Skills & Qualifications

• 6 months customer service experience.
• Payer benefits experience with reimbursement and prior authorizations.
• Healthcare industry experience.
• Advanced knowledge of medical terminology, including sig codes and Roman numerals.
• Knowledge of brand and generic names of medications and general pharmacy terminology.
• National certification through the PTCB or another approved certifying agency.
• Experience with HIPAA and patient services.
• Knowledge of insurance procedures.

Work Environment

This position will be inside a professional office setting, utilizing internal pharmacy management software, PrimeRx. It involves handling both inbound and outbound calls, and adhering to program specific rules and timelines. The role requires maintaining patient confidentiality and compliance with HIPAA regulations while working collaboratively with a team under the supervision of a pharmacist.

Pay and Benefits

The pay range for this position is $18.00 - $18.00

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Louisville,KY.

Application Deadline

This position will be accepting applications until Jan 14, 2025.

FOR THIS TYPE OF EMPLOYMENT STATE LAW REQUIRES A CRIMINAL RECORD CHECK AS A CONDITION OF EMPLOYMENT.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

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

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $18