Insurance Analyst II

Job Title: Insurance Analyst II
Duration: 6 Months
Location: (Remote)
Shift Hours: The hours of operation are 7am-7pm CST. Are you comfortable working one of the following shifts 9:30am-6pm CST or 10:30am - 7pm CST.
Training schedules will run 8:00 am - 4:30 pm CST (**6-10 weeks depending on the role you are selected for.)
shift after training will be later, likely the 10:30am-7pmCST so it is essential that they are okay with working this shift

Purpose:
The primary function of the Insurance Analyst II is to provides best-in-class customer services to patients, Health Care Providers (HCPs) and their staff through referral and call management by investigating patients' insurance benefits and financial assistance opportunities, in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy. This position will be a subject matter expert in insurance billing, claims processing, and prior authorizations. This position liaises between departments, payors, and providers to comprehensively determine patients' overall prescription coverage. The Insurance Analyst I handle patient requests received by phone or electronically (fax, Humira Complete Pro, or other systems) and would complete related outbound calls. This position works collaboratively with other areas of the Pharmacy to maximize patients' access to care.

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.
• 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, and the policies and procedures of Pharmacy Solutions and client.
• Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring client 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.

Qualifications:

• 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.

About Us - Established in 2004, SPECTRAFORCE is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of "human connection," defined by our branding attitude of NEWJOBPHORIA, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com

Benefits - SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

EEOC - SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.

CPRA - Notice to California Applicants: SPECTRAFORCE is committed to complying with the California Privacy Rights Act ("CPRA") effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.