Insurance Analyst I
Chicago (Cook) Sales
Job description
đUSA, Illinois, North Chicago
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Supply Chain & Materials Management
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î¤î¸î 1805155Requisition #
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AbbVie: Determined to Make a Difference [Updated]
People. Passion. Possibilities. Those three simple words mean everything at AbbVie, where patients always come first. So do cutting-edge science and innovation, which fuel our expanding pipeline as we take on the world's toughest health challenges in oncology, immunology, liver disease, women's health and beyond. Together, we strive to make a difference for patients around the world. For more visit: www.abbvie.com.
The primary function of the Insurance Analyst is to investigate patient's insurance benefits and financial assistance opportunities, in addition to processing and monitoring prior authorizations all in an effort to assist the patient in medication procurement. This position will be a subject matter expert in insurance billing, claims processing, and prior authorizations. This position will liaison between departmental personnel, payors, insurers, and providers to comprehensively determine a patient's overall prescription benefit package. The Insurance Analyst uses the core
pharmacy system to manage their workload, perform their duties, and route work to other members of the Pharmacy Solutions operations in order to complete the benefit verification and prescription approval process.
Major Responsibilities:
Responsible for implementing and maintaining the effectiveness of the quality system by
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¡ Provide subject matter expertise on claim billing, insurance coverage/verification, prior authorization and appeal filing, and limited financial assistance opportunities such as (PAP, LIS, Independent Copay foundation, Copay Cards, etc.)
¡ Communicate with insurance payors and providers to investigate pharmacy and medical benefits. Determine patient's financial responsibilities, quantity limits, and prior authorization or pre-certification requirements. Determine medical information requirements and documents required by payors.
¡ Perform QA on benefit verifications and review for reasonableness. Decide whether to reinvestigate or accept. Judge whether to escalate issues/concerns to management
¡ Utilize the appropriate web tools to assess and determine patient eligibility and insurance benefits
¡ Assist offices through the entire document/ information filing process for prior authorizations and appeals
¡ Communicate status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.
¡ Identify and populate the appropriate BV forms, templates and letters in accordance with investigation outcomes and forward to the patient and physician
¡ Contact patient to inform them of benefits and estimated out of pocket expense.
¡ Refer patients to Abbott's Humira Protection Plan, myHUMIRA support program, and other programs as appropriate.
¡ Maintain and build relationships with insurance companies, key referral sources, Pharmacy
¡ Solutions' PSPs, and other key members of Pharmacy Solutions operations team.
¡ Meet performance standards in alignment with predefined metrics
¡ Accurately transmit test claims to verify prescription coverage.
¡ Accurately document all necessary information in all appropriate information systems.
¡ Coordinate with other departments to assure timely claim payments.
¡ Collect data, establish facts, draw conclusions, and solve problems
¡ Participate in the coordination and assembly of patient and physician mailings
Desired profile
Basic:
¡ High school diploma or GED equivalent required.
¡ Associate Degree preferred
¡ Individuals must meet applicable Pharmacy Technician licensure and certification requirements within 15 days of their employment start date in accordance and compliance with the Illinois Pharmacy Practice Act.
Background:
¡ Knowledge of applicable regulations and standards affecting Pharmaceutical Products (e.g. CFR 210/211, cGMP) specifically,
¡ 1-3 years of relevant experience in a healthcare reimbursement and billing setting. Specialty Pharmacy experience desirable
¡ Understanding and knowledge of commercial and major medical insurance programs, billing requirements, healthcare benefit investigation processes, prior authorization and appeal filings.
¡ Government billing experience for filing Medicaid/Medicare claims, appeals, and denials
¡ Accuracy, attention to detail, and fluency in the use of computers¡ Knowledge of Microsoft Office Program Suite and the Lotus Notes Suite including Excel, Word, and SharePoint.
¡ Excellent verbal and written communication skills required.
¡ Ability to manage large work volumes without loss of focus or accuracy
¡ Works well as a team player in a complex high energy environment
Accountability / Scope:
This position is accountable for the accurate and timely filing and processing of prescription claims, prior authorizations,
and appeals in alignment with network pharmacy provider agreements to assure appropriate reimbursement for
prescription drug claims. This position must diligently monitor prior authorizations and appeals working with the physician and office staff to assure a rapid turnaround resulting in procurement of the drug product for the patient. This position will also be responsible for providing financial assistance alternatives and providing the patient with the most cost effective outcome. Finally, this position must understand and comply with all federal, state and local pharmacy laws and regulations, ethical billing practices, and HIPAA policies and guidelines.