Company: Rangam Consultants Inc.
Posted on: May 28, 2023
- The primary function of the Insurance Analyst I 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
- 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
- The Insurance Analyst I handles 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
- 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
- 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
- Identifies potential Adverse Event situations for reporting to
Pharmacovigilance ensuring 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
- 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
- Demonstrated ability to lead and participate within a team,
manage multiple priorities and meet associated timelines while
- 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
- 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
- Reporting onsite daily
- Work independently in group setting
- Assemble and staple reproduced materials as necessary
- Perform other duties as assigned
Rangam Consultants is a minority, women-owned, disability workforce
solutions global organization. Specialized in attracting and
retaining talents globally for a rewarding career in IT,
Engineering, Scientific, Clinical, Healthcare, Administrative,
Finance, Business Management, and many more, while integrating
veterans and individuals with disabilities into the workforce.
Indeed, we connect career aspirants to relevant job opportunities,
be it jobs in USA, UK, India, or Ireland. Also remote jobs,
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Keywords: Rangam Consultants Inc., Chicago , Insurance Analyst, Professions , Chicago, Illinois
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