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9 days old

Insurance Analyst

Kelly Services
North Chicago, IL 60064
Job title: **Insurance Analyst I**


Work location: **Waukegan Road, North Chicago, IL**


Department: **Operations-Pharmacy Solutions**


Job type: **Admin/Clerical**


\# of positions: **12+**


Environment: **Call Center-Insurance Analyst I**


Please note: **Periodic mandatory Overtime**


Shifts & hours: **M-F | During training, the hours would be 8 am-4:30 pm.**


+ **Call Center hours are 7am-7pm** .

+ Once released to the floor, the **shifts options** are as follows:

+ 7am-3:30pm

+ 8am-4:30pm

+ 9am-5:30 pm

+ Additional later shifts may be added to support the business.

+ Business is currently working remotely until stay home order has been lifted.

+ Business will determine timeline for organization and how agents will support either from home or in office


Job description:


+ The primary function of the Insurance Analyst I is to provides best-in-class customer services to patients, Health Care Providers (HCPs) and their staff through referral and call management by investigating patients insurance benefits and financial assistance opportunities, in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy.

+ This position will be a subject matter expert in insurance billing, claims processing, and prior authorizations.

+ This position liaises between departments, payors, and providers to comprehensively determine patients overall prescription coverage.

+ The Insurance Analyst I handle patient requests received by phone or electronically (fax, Humira Complete Pro, or other systems) and would complete related outbound calls.

+ This position works collaboratively with other areas of the Pharmacy to maximize patients access to care.


Job Responsibilities:


+ Provide subject matter expertise on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities.

+ Accurately documents information in the appropriate systems and formats.

+ Communicate the 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.

+ Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.

+ Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits.

+ Obtain and confirm information to maintain Pharmacy Solutions payor intelligence resources.

+ Meet or exceed department standards relative to performance metrics.

+ Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics.

+ Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.

+ Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy.

+ Determine whether to escalate issues/concerns to management for review, guidance, and resolution.

+ Participate in quality monitoring and in identifying and reporting quality issues.

+ Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information

+ Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and the company.

+ Identifies potential Adverse Event situations for reporting to a specific department ensuring the company meets FDA regulations.

+ Completes all required training and performs all functions in the position e.g., Soft Skills certification, product, and disease overviews.

+ Perform additional tasks, activities, and projects as deemed necessary by management.


Qualifications:


+ **High school diploma** or GED equivalent required. Degree preferred.

+ **1-3 years of work experience** in a **healthcare or reimbursement setting** ; call center preferred.

+ Previous experience in a call center environment, healthcare office, corporate setting, or healthcare insurance provider or pharmacy is highly desirable.

+ Must have thorough understanding and **knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations** .

+ Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet associated timelines while maintaining accuracy.

+ Demonstrated strong, accurate technical skills.

+ Must be detail oriented. Professional written and verbal communication skills required.

+ Ability to always maintain a positive service image even when dealing with challenging issues and unsatisfied customers.

+ Proven organizational and problem-solving skills, elevating to management when appropriate.

+ Skilled with the use of the Microsoft Office suite and the ability to use and effectively learn and navigate other computer systems.


Skills/experience needed:


+ Insurance, healthcare, & medical background is key

+ Better understanding of call volume its high!

+ Empathy & patience customers are desperate/frustrated

+ Verifying insurance know the terminology!

+ Ability to deescalate

+ Call center experience is good BUT customer service experience better

+ Office setting background ex. doctors office

+ Computer savvy / technical skills


I am conducting phone interviews. If youre interested in moving forward with the interview process, you can set up a phone interview with me via the following link: http://calendly.com/micb481/15min , Please send me your resume in a word document as well as 2 references before the scheduled interview. If you have any questions, we will answer each one during our interview.


I look forward to speaking with you. Thank you!


**Why Kelly** **** **?**


Youre looking to keep your career moving onward and upward, and were here to help you do just that. Our financial staffing experts will connect you with premier companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in in your career. It all adds up.


**About Kelly** ****


At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/nontraditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live (plus, did we mention we provide a ton of benefits ?). Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.


Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.

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Posted: 2021-06-09 Expires: 2021-07-10

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Insurance Analyst

Kelly Services
North Chicago, IL 60064

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