Patient Billing Associate

Proclinical is currently recruiting for a Patient Billing Associate with a biopharmaceutical company located in Boston, MA.

Job 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.
• Assist offices through the entire documentation and filing process for prior authorizations and appeals.
• Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits.
• Meet or exceed department standards relative to performance metrics.
• 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 information system
• Identifies potential Adverse Event situations for reporting to Pharmacovigilance

Skills and Requirements:

• High school diploma or GED equivalent required. Degree preferred.
• 1-3 years of work experience in a healthcare or reimbursement setting; call center preferred.
• Experience working with Microsoft Office
• 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.

If you are having difficulty in applying or if you have any questions, please contact Brianna Copeland at 267-297-3280.

ProClinical is a specialist employment agency and recruitment business, providing job opportunities within major pharmaceutical, biopharmaceutical, biotechnology and medical device companies.

Proclinical Staffing is an equal opportunity employer.

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