Insurance Analyst II

North Chicago, IL 60064

Posted: 08/15/2019 Category: Pharmacy Job Number: 31349

Now Hiring for a top healthcare company in Waukegan whom are in need of an experienced Pharmacy Reimbursement Manager to become a part of the team! Please apply directly to this posting for consideration! Damian Sroka
  • Pay rate: $28.00 to $30.00 per hour (possible pay increase after 90 days)
  • Hours: 40 hour shift: 2 week training 8: 00 a.m. - 4: 30, post training hours would be a flexible 8 hour shift between 7: 00 a.m. - 7: 00 p.m.

Purpose:
  • The Supervisor of Reimbursement Services provides leadership, support, and supervision for the Reimbursement Services team within Pharmacy Solutions.
  • This individual is a subject matter expert on commercial pharmacy, major medical, and government insurance plans, prior authorizations, appeals, and alternate coverage referrals.
  • The supervisor ensures that all day to day activities of the team operate smoothly and seamlessly to provide the best customer experience for physician offices and ultimately patients.
  • This position is responsible for ensuring all performance metrics, workload deliverables and customer services activities are completed in alignment with a high touch business model

 

Job Requirements

  • Supervise and oversee insurance analysts responsible for verifying new patient insurance benefits and handling claim rejections. Work proactively with staff and cross-functional groups to develop creative solutions to challenging patient access issues regarding prior authorization, pharmacy coordination, and denied coverage requests to ensure patient care.
    Monitor work flow and adjust workload and staffing requirements to ensure that all activities are addressed in a timely and efficient manner.

  • Monitor calls and perform case reviews to ensure accuracy of information, adherence to policies, and excellent customer service. Provide additional coaching and training to individuals as needed. Meet regularly with direct reports to provide direct feedback on their performance and progress against goals.

  • Responsible for writing and communicating performance reviews.

  • Perform administrative tasks such as work hour scheduling, attendance monitoring and counseling, vacation request scheduling, and overtime scheduling. Participate in the hiring process and handle all employee issues for their direct reports.

  • Use effective coaching and management techniques to maintain a highly motivated and interactive work staff.

 

Qualifications:
  • Bachelor’ s degree or Associate Degree in health sciences or business preferred. Comparable or relevant experience will be considered.
  • 3-5 years of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization, appeals, and specialty pharmacy operations
  • 1-2 years supervisory experience in a call center, large physician, managed care, or healthcare insurance setting desired
  • Demonstrated strong, accurate technical skills. Must be detail oriented. Must have a 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 leadership and coaching skills. Demonstrated ability to lead and participate within a team, manage multiple priorities and meet associated timelines while maintaining accuracy.
  • Must have professional written and verbal communication skills to interact with and build and maintain relationships with all levels of the organization. Must maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.
  • Proven organizational, time management, 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.
  • Knowledgeable in applicable regulations and standards affecting pharmaceutical products (e.g. CFR 210/211, cGMP).

Apply now to Damian Sroka for consideration!

Healthcare, call center, mail order medications, Insurance Verification, Medicare, Medicaid, Medical billing, EOB, Benefit, Patient Service, PBM, Enrollment, Provider Services, Pharmacy, prior authorization, reimbursement counselor, Medical customer service, inbound calls, outbound calls, answer phones, make calls, medical terminology, medical office, call center

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