Description:IS1 - Lake Country Rate $30.90. States with lower rates would include:$29.08 – SC, TX, AZ, MI$27.65 – GA, OH, PA, TN, NC$26.30 - $25.65 – FL$26.30 - VAClearance Deadline 8/13Questionnaire must be attached to every resume! 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.) Once released from training, you will be assigned a shift based on business needs. Have you worked in a call center environment previously? To what capacity and what were some of your daily responsibilities? A lot of the patients and calls you are handling are with patients who are experiencing severe illness and hardship times, tell me how you would deal with a customer who might be experiencing difficulties and are very frustrated on the phone? Describe a time when you had to make a decision quickly, and you didn’t have enough information. Describe a situation when you had to work under conditions of uncertainty or unclear goals. Provide an example of when you identified an opportunity to improve efficiency or results. Please tell me about a time when a manager delegated an important project or task to you, how did you handle the task? Were you successful? In this role you will be using web-based applications, what forms of computer systems are you familiar with? On a scale of 1-10, please rate your proficiency with technology-based applications. (In this role we utilize web-based applications such as: Salesforce, Five9 phone system, ChangeHealth, etc.) Have you had a position where there was a quality measurement? How did you work to meet those? Are you comfortable working in a private environment and being expected to have your camera turned on during various meetings? Please confirm that candidate understands and it comfortable with this process by indicating yes or no:Description: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:List up to 10 main responsibilities for the job. Include information about the accountability and scope.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 informationUnderstand 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 AbbVie. Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie 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:List required and preferred qualifications (up to 10). Include education, skills and experience.High school diploma or GED equivalent required. Degree preferred.1-3 years of work experience in a healthcare or reimbursement setting; call center preferred. Previous experience in a call center environment, 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.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 maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.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.Must have access to a secure and private location to work from daily. Provide the days of the week and the hours that this position will require: (No Value)
