What are the responsibilities and job description for the Insurance Specialist I position at AbbVie?
Purpose: Primary goals, objectives or functions or outputs of this position.
The primary function of the Insurance Specialist I is to provides best-in-class customer service to patients, Health Care Providers (HCPs) and their staff by investigating patients’ insurance benefits and financial assistance opportunities in addition to monitoring prior authorizations to assist the patient in starting or continuing therapy. This position will focus on insurance coverage and verification details. This position liaises between departments, payors, patients, and providers to comprehensively determine patients’ overall coverage. The Insurance Specialist I handles requests received by phone or electronic methods and would complete applicable inbound and outbound phone calls. This position works collaboratively with all other functional areas to maximize patients’ access to care.
Responsibilities:
The primary function of the Insurance Specialist I is to provides best-in-class customer service to patients, Health Care Providers (HCPs) and their staff by investigating patients’ insurance benefits and financial assistance opportunities in addition to monitoring prior authorizations to assist the patient in starting or continuing therapy. This position will focus on insurance coverage and verification details. This position liaises between departments, payors, patients, and providers to comprehensively determine patients’ overall coverage. The Insurance Specialist I handles requests received by phone or electronic methods and would complete applicable inbound and outbound phone calls. This position works collaboratively with all other functional areas to maximize patients’ access to care.
Responsibilities:
- Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions.
- Clearly communicate and educate customers on results of the investigation.
- Quickly learn and execute business process and system changes for all drugs and channel sources as applicable.
- Utilize all internal and external electronic tools, communicate/collaborate with payors and providers to investigate insurance coverage efficiently.
- Review system-of-record for all necessary information to complete insurance investigation and call HCP/patient to obtain if necessary.
- Accurately document information in the approved system-of-record, communicate insurance details to all required recipients and formats as per established policies and procedures.
- Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.
- Work cross-functionally to identify and share opportunities for process and productivity improvements.
- 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 AbbVie. Complete all required training and perform all functions in the position (i.e., Role certification, product and disease overviews).
- Meet or exceed department standards relative to performance and quality metrics. Perform additional tasks, activities, and projects as deemed necessary by management.
Qualifications:
- High school diploma or GED equivalent required. College 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.
- 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 is preferred.
- 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 maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers and payors.
- 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.
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