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Insurance Verification Specialist - Level 1
Specialist, Insurance Verification (Conversion-Level 1)
Desired qualifications, skills and experience:
Current Pharmacy Technician License/Registration without restrictions with State Board of Pharmacy in the State in which the position is located or National Technician Certification
Relevant work experience in a Specialty Pharmacy, PBM, and/or call center setting
Associate's Degree in healthcare, business, or related area of study
Required qualifications, skills and experience:
Minimum Required Qualifications
Beginning proficiency in Microsoft Office Suite of programs
Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner
Strong initiative with the ability to work in a team environment
Organized and detail oriented with proven problem solving skills
AllianceRx Walgreens Prime delivers maintenance medicines and specialty medicines through its mail service and central specialty pharmacies. Formed in 2017 through a strategic alliance between Walgreens, one of the nation's largest chain drug stores, and Prime Therapeutics, a leading pharmacy benefit manager (PBM), we offer tools and resources to help patients improve medication adherence, 24/7 pharmacy support for exceptional care. The company is headquartered in Orlando, FL and its pharmacies are accredited by several national pharmacy accreditation services.
AllianceRx Walgreens Prime is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
If you'd like more information about your EEO rights as an applicant under the law, please review EEO is Law at ~~~ and the EEO is Law Supplement at ~~~
To view our Pay Transparency Statement, please click here: Pay Transparency Statement at ~~~
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Insurance Verification Specialist - Level 1 is responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services including, but not limited to, major medical insurance benefits (including Medicare), complex insurance plans, and high volume PBM plans. This position needs to understand the authorization process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical, and PBM.
Utilizes all available resources to obtain and enter insurance coverage information for ordered services; Verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits (including Medicare) or pharmacy benefits; Facilitates and completes the prior authorization process with insurance companies and practitioner offices
Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices; Investigates and facilitates prior authorization and any other claim rejections
Notifies patients, physicians, practitioners, and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility
Communicates with other departments and senior managers as necessary to facilitate urgent needs; Places outbound calls to patients or physicians' offices to obtain additional information needed to process requests; Manages inbound calls on the insurance line from patients, clients, physicians, practitioners, and clinics regarding inquiries about services provided, financial responsibility, and insurance coverage
Other responsibilities as judgment or necessity dictate