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T
TEKsystems
Insurance/Reimbursement Specialist
Career Insights for Medical Claims Processor / Representative
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What they do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
$41,153 / year median in the U.S.
-3% projected decline
Job Description
Job Description:
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.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 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. + Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information Additional Skills & Qualifications + A+ Candidates will have pharmacy call center experience + A- Candidates will have healthcare call center and medical claims experience + 1-3 years of work experience in a healthcare or reimbursement setting + Previous experience in a call center environment, healthcare office, corporate setting, or healthcare insurance provider or pharmacy is required + Must have thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations. Job Type & Location This is a Contract position based out of Tampa, FL. Pay and Benefits The pay range for this position is $20.00 - $20.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:- 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 remote position.