इंडिपेंडेंट हेल्थ पश्चिमी न्यूयॉर्क की एक स्वास्थ्य बीमा संस्था है और इस क्षेत्र के शुरुआती स्वास्थ्य रखरखाव संगठनों (HMO) में से एक है। यह 100 से अधिक योजनाओं, उत्पादों और सेवाओं के माध्यम से लगभग 3,55,000 लोगों को कवरेज और संबंधित सेवाएँ प्रदान करती है। इसके कार्यों में वाणिज्यिक स्वास्थ्य बीमा, फार्मेसी लाभ, मेडिकेयर एडवांटेज और स्व-वित्तपोषित स्वास्थ्य योजनाएँ शामिल हैं। कंपनी अपनी संस्कृति को सदस्यों और कर्मचारियों को अपनी सर्वोत्तम क्षमता सामने लाने में मदद करने पर केंद्रित बताती है।
Hybrid Billing Specialist - Pharmacy and Medical Claims
Process pharmacy and medical claims for Reliance Rx specialty pharmacy in a hybrid Williamsville role. Resolve rejections, payor issues, patient assistance needs, and portal activity.
विवरण
- Process and adjudicate pharmacy and medical claims, including rejected claims
- Track rejected claims, complete follow-up, and help meet delivery commitments
- Serve as a point of contact between patients and insurance providers
- Coordinate communication among patients, physicians, clinical staff, and administrative teams
- Work with payors to investigate and resolve billing concerns
- Maintain Reliance Rx compliance with CMS requirements and Medicare and Medicaid guidance
- Verify claim accuracy along with payor billing and shipping requirements
- Prepare and arrange deliveries to medical offices
- Submit medical claims for medications and supplies
- Validate the financial details of claims before they leave the facility
- Administer the portal, including refill reminders, portal orders, and patient enrollment
- Arrange patient financial assistance through foundations, copay programs, and free medication services
- Support Patient Care Specialists with workflow coordination and inbound and outbound calls
- Maintain patient files and complete required filing and documentation
- Complete system setup and data-entry activities
- Manage payment arrangements and collect copayments
- Support medical offices with prior authorization requests
- Coordinate insurance benefits
- Encourage information sharing and ongoing process improvements
- Follow established written procedures and guidelines, obtaining supervising pharmacist approval for deviations
आवश्यकताएँ
- High school diploma or GED is required
- National Pharmacy Technician Certification (CPhT) is preferred
- At least one year of experience in a high-volume pharmacy or comparable setting is required; six months as a temporary associate in Reliance Rx Operations & Compliance may qualify
- Experience with an online claims processing system is preferred
- Strong verbal and written communication skills
- Comfort working with other healthcare professionals
- Ability to lift at least 5 pounds
- Demonstrated alignment with Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive
- This position does not offer immigration or work visa sponsorship
लाभ
- Scorecard-based incentive
- Comprehensive benefits package
- Generous paid time off