Insurance Resolution Specialist, Rare Disease Pharmacy
Overview
You will verify pharmacy and medical claims for patients with rare diseases, ensuring accurate billing and timely medication delivery. Working with the Patient Access team at PANTHERx Specialty, the nation's largest rare disease pharmacy, you will handle pharmacy benefit systems, Cover My Meds, and EDS billing across a high-volume caseload. This mid-shift hybrid role (9:30 AM or 10:00 AM start) sits between patients, insurers, and government agencies. You will own the financial clearance process from benefit verification to copay assistance, reducing patient friction and supporting specialty treatments for 7,000+ conditions.
What You'll Do8
- 1Verify all benefit information needed to process pharmacy or medical claims, using Cover My Meds and EDS billing systems.
- 2Process pharmacy claims on the patient's behalf through the pharmacy benefit system, ensuring accurate adjudication.
- 3Verify medical benefits for each patient, capturing coverage details and limitations.
- 4Obtain authorizations and overrides from insurance providers, coordinating with payers to secure approvals.
- 5Process patient information for copay cards and assistance programs, applying funds to reduce out-of-pocket costs.
- 6Review financial responsibility with patients, obtaining consent and payment for their prescribed medications.
- 7Set up prescription shipments, coordinating with pharmacy operations to ensure timely delivery.
- 8Support special projects, including process improvements and payer contract implementations.
Requirements7
- 12+ years experience processing pharmacy claims and benefit investigations in a specialty or retail setting.
- 2High school diploma or GED; CPR+ experience is preferred.
- 3Proficiency with Cover My Meds and EDS billing systems, plus Excel and Word.
- 4Strong written and verbal communication skills to explain coverage and financial options to patients.
- 5Ability to multitask across multiple patient cases in a fast-paced environment.
- 6Knowledge of prior authorization processes and medical benefit verification.
- 7Experience in mail order or specialty pharmacy is preferred.
Salary Insight
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