Insurance Verification Specialist - Specialty Pharmacy

Job Description: The purpose of this position is to help patients get access to the medications and therapies that they need.

• Compensation: $19-22/hr.
• Location(s): 9400 Southpark Center Loop, Suite 200, Orlando, Florida 32819
• Onsite Requirement: This role does require onsite availability, but may offer hybrid and/or remote opportunities once requirements are met.

This role works directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. The Insurance Verification Specialist will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications.

• Ensure cases move through the process as required in compliance with company requirements and the organization’s defined standards and procedures; in a manner that provides the best level of service and quality.
• Conduct benefit investigations for patients by making outbound phone calls to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers.
• Verify patient specific benefits and document specifics including coverage, cost share and access/provider options.
• Identify any coverage restrictions and details on how to expedite patient access.
• Document and initiate prior authorization process and claims appeals.
• Report any reimbursement trends or delays in coverage to management.
• Act as a liaison for field representatives, health care providers and patients.

• In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
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• 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage.
• 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements.
• Excellent verbal communication skills and grammar.
• Salesforce system experience preferred.

• Medical, dental, vision, life, & short-term disability insurance.
• Teledoc services for those enrolled in medical insurance.
• Supportive, progressive, fast‑paced environment.
• Competitive pay structure.
• Matching 401(k) with immediate vesting.
• Legal insurance.

Assist Rx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or any other protected categories protected by federal, state, or local laws.