Patient Billing Associate
Proclinical is currently recruiting for a Patient Billing Associate with a biopharmaceutical company located in North Chicago, IL.
- 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 information
- Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines.
- Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring the company 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.
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. 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.
If you are having difficulty in applying or if you have any questions, please contact Catherine Nguyen at 215-531-5643.
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.