Description
DESCRIPTIONThe Insurance Analyst will investigate a patient's insurance benefits, process and monitor prior authorizations and appeals, and identify alternate funding options (eg, copay cards, independent copay foundations, and patient assistance programs).
Responsibilities:
- Run test claims, utilize web tools, and/or contact insurance providers via phone to investigate pharmacy and medical benefits.
- Communicate the insurance benefits, prior authorization/appeal requirements, and alternate funding options to the physician and/or the patient via phone, fax, and/or mail.
- Perform a variety of complicated tasks.
- Compounds and dispenses medical prescriptions.
- Accurately document all necessary information in appropriate information systems.
- Perform some clerical duties relating to the department.
- May lead and direct the work of others.
- Requires a high school diploma or its equivalent and at least five years of experience in the field or in a related area.
- Knowledge of benefits reimbursement.
- A wide degree of creativity and latitude is expected.
- Must have a background of one to three years of recent experience in a healthcare reimbursement and/or billing setting.
- Communicates information to patients and physicians using excellent customer service skills.
- Thorough understanding and knowledge of pharmacy and major medical insurance programs, billing requirements, healthcare benefit investigation processes, prior authorization and appeal filings.
- Knowledge of government programs, including Medicare and Medicaid.
- Excellent verbal and written communication and customer services skills required
- Must understand and comply with all federal, state and local pharmacy laws and regulations, ethical billing practices, and HIPAA policies and guidelines.
- Familiar with a variety of the field's concepts, practices, and procedures.
- Relies on experience and judgment to plan and accomplish goals.
SKILLS
Requires a high school diploma or its equivalent and at least 5+ years of experience in the field or in a related area.
Synectics is an Equal Opportunity Employer.