Independent Health — G‘arbiy Nyu-Yorkda faoliyat yurituvchi tibbiy sug‘urta tashkiloti va mintaqadagi eng qadimgi Sog‘liqni saqlashni boshqarish tashkilotlaridan (HMO) biridir. U 100 dan ortiq reja, mahsulot va xizmatlar orqali taxminan 355 000 kishiga sug‘urta qoplamasi hamda tegishli xizmatlarni taqdim etadi. Tashkilotning faoliyat yo‘nalishlariga tijoriy tibbiy sug‘urta, dorixona imtiyozlari, Medicare Advantage va o‘z mablag‘i hisobidan moliyalashtiriladigan tibbiy rejalar kiradi. Kompaniya o‘z madaniyatini a’zolar va xodimlarga o‘z imkoniyatlarini to‘liq namoyon etishga yordam berishga yo‘naltirilgan deb ta’riflaydi.
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.
Tavsif
- 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
Talablar
- 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
Imtiyozlar
- Scorecard-based incentive
- Comprehensive benefits package
- Generous paid time off