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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in benefit investigations, prior authorizations, and patient accounting within the insurance and pharmaceutical industries. Proficient in data management and communication, ensuring compliance with safety and environmental standards.
Highest-signal resume keywords
Benefit InvestigationsPrior AuthorizationsPatient AccountingHealth Insurance ClaimsCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data EntryAnalytical SkillsMedical TerminologyThird Party BillingCoding
Soft Skills
Detail OrientedAbility To Manage Multiple PrioritiesExcellent Written CommunicationExcellent Verbal Communication
Tools & Technologies
MS Office ApplicationsDatabase Management
Industry Keywords
BiotechnologyPharmaceuticalCustomer ServiceReimbursementREMS Requirements
About the role
Key responsibilities & impact- Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices
- Submit and obtain prior authorizations as required by payers
- Obtain recertification for cases requiring extended treatment or coverage
- Accurately enter and maintain data in client databases and patient files
- Monitor outstanding items and ensure files are complete
- Participate in conference calls with Client Sales Representatives, client management, and physicians’ offices
- Coordinate product orders, shipments, and therapy initiation with pharmacies and patients
- Participate in call center activities and triage incoming calls
- Serve as a single point of contact for assigned prescribers when required
- Identify and report events according to REMS requirements
- Recognize adverse events, product quality complaints, and potential risk events and forward them for manufacturer reporting
- Educate patients, prescribers, and others regarding program requirements
- Facilitate referrals
- Maintain housekeeping, quality, production, safety, and environmental standards
Requirements
What you’ll need- High School Diploma/GED or equivalent experience
- 4–6 years’ experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement
- Health Insurance claims or patient accounting experience a plus
- Computer proficiency in MS Office applications, with database experience a plus
- Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels
- Ability to manage multiple priorities and meet deadlines
- Detail oriented with good analytical skills
- Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred
- Comply with all applicable company, state, and federal safety and environmental programs and procedures
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match
- Tuition reimbursement
- Flexible work environment
- 20 days PTO
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs