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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 reimbursement processes within the insurance and pharmaceutical industries. Proficient in managing client databases and providing exceptional customer service while ensuring compliance with REMS requirements.
Highest-signal resume keywords
Benefit InvestigationsPrior AuthorizationsCustomer ServiceHealth Insurance ClaimsMedical Terminology
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 EntryReimbursement ProcessesThird Party BillingCodingAnalytical Skills
Soft Skills
Excellent Communication SkillsDetail OrientedAbility to Manage Multiple Priorities
Tools & Technologies
MS Office ApplicationsDatabase Management
Industry Keywords
BiotechnologyPharmaceuticalPatient AccountingREMS Requirements
About the role
Key responsibilities & impact- Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices
- Submit and obtain prior authorizations and obtain recertification for extended treatment or coverage
- Accurately enter and maintain data in the client database and patient files
- Monitor outstanding items on client case files and ensure files are complete
- Participate in conference calls with Client Sales Representatives, client management, and physicians’ offices
- Coordinate product orders, product shipment, and therapy initiation with pharmacies and patients
- Participate in call center activities and triage incoming calls from patients, insurers, physicians, sales representatives, pharmacies, and homecare agencies
- Serve as a possible single point of contact for assigned prescribers
- Identify and report events required by 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 and facilitate referrals
- Maintain housekeeping, quality, production, safety, and environmental standards
- Provide customer service and support reimbursement processes to expedite patient access to client products and maximize reimbursement
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
- Ability and willingness to travel as required
- Must be available to work a full-time assigned schedule from 11:00 AM to 8:00 PM Eastern Time, Monday through Friday
- Candidates outside the Eastern Time Zone must be able to work the assigned shift based on Eastern Time business hours
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match
- Tuition reimbursement
- Flexible work environment
- 20 days PTO
- 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