Insurance Verification Specialist jobs in Florence, SC

Job description

Title: Insurance Specialist - Pharmacy

Reports To:

Pharmacy Billing Director

Updated on: 6/23/2023

Approved By: Human Resources

POSITION SUMMARY

Under the supervision of a Registered Pharmacist and/or the Director of Pharmacy Financial Operations, the Insurance Specialist (MUST BE STATE AND NATIONALLY CERTIFIED PHARMACY TECHNICIAN) performs various functions with an emphasis on correct billing of claims, researching claims and following up on Pharmacy reimbursement.

ESSENTIAL FUNCTIONS:

Typical Essential Functions include but are not limited to the following:

1. Review and process third party claims for prescription medications.

2. Daily Refills.

3. Work denied/rejected claims in a timely manner to ensure quick adjudication.

4. Adjudicate claims through Pharmacy Benefits Manager.

5. Patient calls regarding medications being ready to pick up.

6. Patient calls in order to solve billing problems.

7. Determine if prior authorization or pre-certification is necessary and act accordingly.

8. Provide great customer service to patients.

9. Completing daily reports both timely and accurately.

10. Scanning and attaching files to patient charts in Success (EMR).

11. Faxing various insurance documents as required.

12. Maintain required spreadsheets as daily reports are worked.

13. Willingness to perform other duties as assigned and /or required.

Operational Excellence

14. Ensure and uphold the confidentially requirements of all patient records and manage all daily tasks and activities consistent with HIPAA, State and Federal Laws and Regulations, as well as the clinic’s policies and regulations regarding confidentiality and security.

Relationships

Develop and ensure effective, positive relationships within and among the clinic staff, as well as with patients, vendors, contractors, and related resources.

Professionalism

15. Ensure all actions, job performance, personal conduct and communications represent the organization in a highly professional manner at all times.

16. Uphold and ensure compliance with and attention to all corporate policies and procedures, as well as the mission and values of the organization.

ESSENTIAL FUNCTIONS/KEY COMPETENCIES

1. Function in a multi-tasking, multiple priorities environment, while maintaining accuracy and attention to detail.

Title: Insurance Specialist - Pharmacy

Reports To:

Pharmacy Billing Director

Updated on: Nov 2021

Approved By: Human Resources

2. Communicate with a diverse employee population. Will be required to successfully manage vendors in often stressful or conflict situations.

3. Utilize a wide variety of office technology and tools to collect, enter, process, file purchasing records and documentation.

POSITION REQUIREMENTS

Education

· High School Diploma or equivalent required.

· Professional

· Must have completed an accredited Pharmacy Technician Training Program or at least 1-2 years’ experience.

· Must be State Licensed by LLR and PTCB certified.

· Experience working in a nonprofit organization preferred but not required.

· Ability to handle confidential information in a discreet, professional manner.

· Communication, customer service or working with the general public, preferably in a medical care facility.

· General computer competence including basic Word, Excel, and potential to be trained on specific software for patient information, billing and communication.

· Knowledge of Medical Terminology preferred.

Physical/Environmental

· Ability to interact with computer screen for up to six hours at a time (visual acuity required).

· Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.

· Capacity to function in a sometimes stressful, multi-tasking environment

Blood Borne Pathogen Exposure (Please Check One)

_____ Category I: Job Classification includes ALL employees who have Occupational Exposure* to Blood Borne Pathogens* (blood or body fluids) while performing their job duties.

____ Category II: Job Classification includes employees who are likely to have SOME Occupational Exposure to Blood Borne Pathogens because Category I tasks may occasionally be required.

____ Category III: Job Classification includes those employees who perform jobs and tasks where NO CONTACT with Blood Borne Pathogens occurs and Category I and Category II tasks ARE NOT a condition of employment.

LIMITATIONS/DISCLAIMER:

1. The above job description is meant to describe the general nature and level of the work being performed; it is not intended to be construed as an exhaustive list of all job responsibilities, duties and skills required for the position.

2. All job requirements are subject to possible modifications to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.

3. This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related duties requested by their supervisor in compliance with federal and state laws.

4. Requirements are representative of minimum levels of knowledge, skills, and/or other abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Please review the employee manual carefully.

It determines the nature and extent of the employment relationship, and you must familiarize yourself with its contents, and adhere to all of the policies and procedures of GHC, whether set forth in the manual or elsewhere. The policies, procedures and standard practices described in the manual, including this document, are not conditions of employment. The manual does not create an express or implied contract between GHC and any of its employees. GHC reserves the right to terminate any employee, at any time, with or without notice or procedure, for any reason deemed by the Company to be in the best interests of the Company, including for no reason at all. The information in the manual and/or otherwise presented by the Company represents guidelines only, and GHC reserves the right to modify the manual, amend or terminate any policies, procedures, or employee benefit programs whether or not described in the manual at any time, or to require and/or increase contributions toward these benefits programs.

Job Type: Full-time

Salary: Starting at $18.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• High school or equivalent (Preferred)

Experience:

• Pharmacy technician experience: 1 year (Preferred)

Shift availability:

• Day Shift (Preferred)

Work Location: One location

Closed

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Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Olanta, SC 29114: Reliably commute or planning to relocate before starting work (Required)

Experience:

• ICD-10: 1 year (Preferred)

Work Location: In person