Medical CoPay Claims Processor

DUTIES AND RESPONSIBILITIES:

• Processes medical copay claims in accordance with program business rules.
• Liaison with other program-specific AssistRx resources to secure outcomes for active patients.
• Performs outbound calls to inform and collect missing information.
• Ensures accuracy with attention to detail for copay claim processing and additional data collection.
• Performs other related duties as assigned by management.
• Perform daily reconciliation of batch postings, including automated/manual claim inputs.
• Analyze claims for accuracy based on insurance coverage, cost of goods, allowable amounts, and copays.
• Troubleshoot rejected claims and process prior authorizations or overrides.
• Maintain working knowledge of prescription plans and billing policies to ensure compliance and reimbursement.
• Monitor profitability of orders, manage claim queues (e.g., 3 & 5, 541, B queues), and adjust last events accordingly.
• Ensure timely claim submissions and adherence to adjudication and delivery windows.
• Coordinate with the Financial Assistance Department for additional funding when necessary.
• Promptly report reimbursement changes, underpayments, pricing discrepancies, or cost assistance needs.

Requirements

• College degree is preferred or a high school diploma with equivalent combination of education and experience.
• Other skills required:
• Previous work experience in Medical Reimbursement including HICF forms and EOBs.
• Comprehensive understanding of Explanation of Benefits and application of patient benefit including HCPCs level II and CPT codes.
• Processing claims and resolving denial instances
• Calculate patient responsibilities for copay reimbursement for services provided as outlined within the program business rules.
• Strong understanding of Government benefits such as Medicare, Medicaid, and Tricare.
• Documenting and reporting payment information.
• Professional level skills in computer use, including but not limited to Microsoft Office Suite, web-based applications, and keyboard skills.
• Demonstrated strong written and verbal communication skills with providers, patients and insurance companies.
• Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics.
• Problem solving skills.

COMPETENCIES:

• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values

Benefits

• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance

AssistRx, 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 other non-merit based factors, or any other protected categories protected by federal, state, or local laws. All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position. AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire Apply tot his job Apply To this Job