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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 managing client communications and ensuring compliance with REMS requirements while providing exceptional customer service.
Highest-signal resume keywords
Benefit InvestigationsPrior AuthorizationsPatient AccountingHealth Insurance ClaimsExcellent Communication 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 EntryThird Party BillingMedical TerminologyCodingAnalytical Skills
Soft Skills
Detail OrientedAbility to Manage Multiple Priorities
Tools & Technologies
MS Office ApplicationsDatabase Experience
Certifications & Qualifications
High School Diploma/GED
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 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 regarding case status, drug orders, and alternative funding
- Coordinate product orders, product shipments, and therapy initiation with pharmacies and patients
- Participate in call center activities, including triaging and responding to incoming calls
- Serve as a single point of contact for assigned prescribers when needed
- Identify and report events required by REMS requirements
- Recognize adverse events, product quality complaints, and potential risk events and forward information for manufacturer reporting
- Educate patients, prescribers, and others regarding program requirements
- Facilitate referrals
- Maintain housekeeping, quality, production, safety, and environmental standards
- Provide customer service and interface with patients, families, national payers, home cares, and medical doctors’ offices to expedite patient treatment 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
- Candidates must have a HIPAA-compliant workspace and reliable high-speed internet
- Candidates must be available Monday through Friday, 9:00 AM–6:00 PM EST; there is no flexibility in the shift
- Scheduled time off cannot be accommodated during the contract period
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 and long term disability
- Life insurance
- Discount programs
- UBC will provide all required equipment, including desktop hardware and software