Benefit Investigation Specialist

Job Title: Benefit Investigation Specialist
Location: Pittsburgh, PA 15275
Duration: 2 Months+ (Possibilities of Extension)
 
Job Description:
Responsible for direct contact with Medical Insurance Payers and Pharmacy Benefit Managers in order to identify and document available coverage options for retail and specialty medications. Maintains high quality customer service standards in compliance with federal and state regulations and guidelines.
 
Duties:

• Makes outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits
• Communicates case details to appropriate internal or external parties once benefit verification is complete
• Identify any payer coverage restrictions and potential mechanisms for quickly accessing therapy
• Ability to effectively contribute alone or in small work groups
• Effectively meets production and time completion goals
• Accurate document payer Prior Authorization and Appeals protocols
• Participate in special projects and perform additional duties as required
• Maintain repository of payer or brand specific coverage information
• Participating in training and process improvement initiatives

 
Required Qualifications:

• Minimum of 2 years’ experience in customer service, insurance, benefits, marketing, sales, or related area, required, or bachelor’s degree and 1 year of relevant experience
• High school diploma or equivalent, required. Bachelor’s degree
• Health care environment with third party benefits verification experience preferred.