AllianceRx Walgreens Prime Senior Insurance Verification Specialist in Frisco, Texas



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Senior Insurance Verification Specialist

About us:

AllianceRx Walgreens Prime delivers maintenance medicines and specialty medicines through its mail service and central specialty pharmacies. Formed in 2017 through a strategic alliance between Walgreens, one of the nation’s largest chain drug stores, and Prime Therapeutics, a leading pharmacy benefit manager (PBM), we offer tools and resources to help patients improve medication adherence, 24/7 pharmacy support for exceptional care. The company is headquartered in Orlando, FL and its pharmacies are accredited by several national pharmacy accreditation services.

Desired qualifications, skills and experience:

Preferred Qualifications

  • Pharmacy Technician License or Certification preferred unless required by state as granted by the state Board of Pharmacy or nationally recognized certification agency.

  • At least 3 years of experience in call centers.

  • Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font).

  • At least 3 years of experience in a healthcare or pharmacy setting.

EEO statement:

AllianceRx Walgreens Prime is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

If you'd like more information about your EEO rights as an applicant under the law, please review EEO is Law and the EEO is Law Supplement

To view our Pay Transparency Statement, please click here: Pay Transparency Statement

If you need an accommodation or assistance in using the AllainceRx Walgreens Prime Careers website, please click here .

Required qualifications, skills and experience:

Basic Qualifications

  • High school diploma/GED .

  • At least 3 years of experience in pharmacy benefit or medical benefit insurance billing OR 1 year of experience as an Insurance Verifier or similar position with Specialty Pharmacy.

  • At least 3 years of experience providing customer service to team members and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.

  • Experience developing ways of accomplishing goals with little or no supervision, depending on oneself to complete objectives and determining when escalation of issues is necessary.

  • Problem solving experience.

  • Willing to work mandatory extra hours, this may include evenings, weekends and/or hours outside of normal business hours.

  • Basic math skills including addition, subtraction, multiplication and division.

  • Keyboarding skills basic level (for example: operate by touch the letter, number, and symbol keys with minimal errors).

  • Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).

  • Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns)

  • Basic Internet Explorer skills experience to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online.

  • Basic level PC skills (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents, access information on-line, etc.).

Job description:

Job Summary

Acts as a lead, coordinating the work of Insurance Verifiers. Resolves more complex issues related to patient coverage/responsibility for services.

Job Responsibilities

  • Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file.

  • Verifies patient insurance coverage of medications, administration supplies and related pharmacy services.

  • Subject matter expert in completing the Prior Authorization process with insurance companies and practitioner offices; Acts as subject matter expert in completing a full Medical Verification for all medications, administration of supplies and related pharmacy services.

  • Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility; Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization on any other insurance rejections; Provides notification of urgent orders to the Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary.

  • Places outbound calls to patients or physicians offices to obtain additional information needed to process the script or to notify of delay in processing script; Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.

  • Acts as a subject matter expert in fixing and adjusting past claims including working with finance for approved claim adjustments after insurance approvals.

  • Participates in test and implementation of system updates and new plan implementations.

  • Assists with workflow management, issue resolution and training in addition to or in the absence of a supervisor; Assists with auditing and reporting of the other technicians including compiling AUX reporting and order audits.

  • May assist in training of new team members and may provide input to the employees’ performance evaluations.

  • Acts as a resource for colleagues; may direct the work of other staff members.

  • Works autonomously to handle more complex issues related to patient coverage/responsibility for services.