Medical Program Insurance Specialist

Posted 9 months ago

Job Title: Medical Program Insurance Specialist
Reports to: Call Center Supervisor

AllCare Plus Pharmacy works with all major insurance companies. We are also well networked
with manufacturers and assistance programs for patients who need additional coverage. Our
bottom line is making sure that coverage does not become a barrier to patient care.
Our Insurance Specialists are responsible for contacting insurance companies to obtain correct
eligibility information, perform benefit investigations and check prior authorization and/ or
appeal status. As well as assisting patients with copay assistance enrollment process and
answering patient insurance related questions.

• Responsible for answering in-bound calls and assisting customers with pharmacy related
• Obtain client information by answering telephone calls; interviewing clients; verifying
• Contact insurance companies for benefit investigation and coverage eligibility
• Complete prior authorizations with attention to detail and accuracy, to then have the prepared
prior authorization reviewed by a clinical pharmacist
• Assist patients with the enrollment process for manufacturer and non-profit organization
copay assistance programs
• Provide customers with courteous, friendly, fast and efficient service
• Update job knowledge by participating in educational opportunities and training activities.
• Work efficiently both individually and within a team to accomplish required tasks
• Maintain and improve quality results by adhering to standards and guidelines and
recommending improved procedures

• Represent AllCare Plus Pharmacy as an employer of choice
• Follow the AllCare core values and policies
• Ability to successfully work in a team environment
• Excellent customer service skills and professionalism
• Strong interpersonal skills
• Excellent written and verbal communication skills
• Excellent listening skills and the ability to ask probing questions, understand concerns, and
overcome objections
• Problem solving skills
• Bilingual (Spanish) is highly desirable
• Educational Requirements
o High School Diploma or equivalent. Some college preferred
• Required Qualifications
o Minimum one year of experience in a health care setting
Job Description AllCare Plus Pharmacy, Inc.
Rev 1/2017 Job Descriptions –Medical Program Insurance Specialist Page 2 of 2
o Minimum one year experience in medical billing, insurance verification, or similar
related medical office experience
o Previous data entry experience (minimum three months) and ability to type 30wpm+
o Strong work ethic and self-starter, able to effectively manage multiple priorities and
adapt to change within a fast-paced pharmacy environment
o Excellent customer service skills and professionalism
o Knowledge and ability to use Internet, MS Word & Excel
o Working knowledge of insurance types, terminology and processes
o Flexible work schedule preferred
This job has no supervisory responsibilities

Problem Solving – Identifies and resolves problems in a timely manner; Gathers and
analyzes information skillfully; Develops alternative solutions; Works well in group problem
solving situations; Uses reason even when dealing with emotional topics.
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; Maintains confidentiality
Verbal Communication – Speaks clearly and persuasively in positive or negative situations;
Listens and gets clarification; Responds well to questions.
Written Communication – Writes clearly and informatively; Able to read and interpret
written information
Teamwork – Balances team and individual responsibilities; Exhibits objectivity and
openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team
spirit; Inspires respect and trust
Leadership – Exhibits confidence in self and others; Inspires and motivates others to
perform well.
Diversity – Demonstrates knowledge of EEOC policy; Shows respect and sensitivity for
cultural differences and promotes a harassment-free environment.
Ethics – Treats people with respect; Works with integrity and ethically; Upholds
organizational values
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; Looks for ways to improve and promote
quality; Monitors own work to ensure quality.
Safety and Security – Observes safety and security procedures; Reports potentially unsafe
Attendance/Punctuality – Is consistently at work and on time; Ensures work responsibilities
are covered when absent

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