New

Pharmacy Claims Specialist

TEKsystems
$16.00 - $18.00 / hr
medical insurance, life insurance, sick time, 401(k), retirement plan
United States, Texas, Houston
Jan 08, 2025
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 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. * 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. * 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. * Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information * Understand 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 and . Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring company meets FDA regulations. * Completes 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 necessary by management. Qualifications -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 (highly preferred). -Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet associated timelines while maintaining accuracy. -Demonstrated strong, accurate technical skills. -Must be detail oriented. -Professional written and verbal communication skills required. -Ability to always maintain a positive service image even when dealing with challenging issues and unsatisfied customers. Hours The hours of operation are 7am-7pm CST. Shifts will be assigned, candidates do not get to choose their shift Training schedules will run 8:00 am - 4:30 pm CST 6-10 weeks with a March 3rd start date Once released from training you will be assigned a shift based on business needs. Required to have access to a secure and private location to work from daily. No time-off requests will be approved during training. Any absences during training will be considered unplanned. Pay and Benefits The pay range for this position is $16.00 - $18.00 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. Application Deadline This position will be accepting applications until Jan 21, 2025. 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.