Remote Insurance Analyst II

Aston Carter Remote
remote insurance analyst insurance pharmacy billing patients management healthcare medical health providers corporate
January 22, 2023
Aston Carter
North Chicago, Illinois
Qualifications:

Case management experience, insurance knowledge, prior authorizations, claims/billing knowledge and good tenure!

High school diploma or GED equivalent required. Degree preferred.

2-5 years of work experience in a healthcare or reimbursement setting; needs a thorough understanding of insurance. Previous experience in a healthcare office, corporate setting, or healthcare insurance provider or pharmacy is highly desirable.

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.

Proven organizational and problem solving skills, elevating to management when appropriate.

Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.

Description:

The primary function of the Insurance Analyst II is to work with patients, Health Care Providers (HCPs) and their staff through referral and 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 II handles patient requests received by phone or electronically.

This position works collaboratively with other areas of the Pharmacy to maximize patients' access to care.

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 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

Hours:

Remote

Business hours are M-F 7am-7pm. Overtime is needed at times. Business will determine if it could be voluntary or mandatory

About Aston Carter:

Please Note: Scammers are posing as Aston Carter. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.

At Aston Carter, we're dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions - from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients' capabilities by seeking solvers and delivering solutions to address today's workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.

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.

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 call 888-237-6835 or email [email protected] (%[email protected]) for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.

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