Job Title:

Insurance Analyst I Duration:

Months Location:

(Remote)

Shift Hours:

The hours of operation are 7am-7pm CST. Are you comfortable working one of the following shifts 9:30am-6pm CST or 10:30am - 7pm CST. Training schedules will run 8:00 am - 4:30 pm CST (•6-10 weeks depending on the role you are selected for.)

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:

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.\nAssist 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.\nUse 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.\nMeet 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.\nDecide 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.\nEnter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information\nUnderstand 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 .• Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring client meets FDA regulations.\nCompletes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews. Perform additional tasks, activities, and projects as deemed neces

Qualifications:

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