Insurance Specialist

At Pixel, we’re on a mission to connect a fragmented healthcare system through a unified fertility management and support platform. We bring patients, providers, and pharmacies together, so information flows freely, questions are answered, and treatment is supported every step of the way. We believe patients deserve more than prescriptions — they deserve guidance, education, and compassionate support throughout their fertility journey. That’s why we’re building a platform that empowers patients while connecting them with the healthcare professionals, resources, and community they need to feel informed and supported. About the Role We’re looking for a detail-oriented, resourceful Insurance Specialist to help patients navigate the often-complex insurance and medication access process. This is a full‑time, on‑site position based at Pixel’s satellite location in Cedar Knolls, NJ with a Monday through Friday schedule, 9 am to 5:30 pm. In this role, you’ll conduct comprehensive benefits analysis, perform and manage prior authorizations, investigate rejected pharmacy claims, and help identify available coverage and patient financial assistance opportunities. Working across payer portals, pharmacy systems, and other resources, you’ll help patients better understand their benefits and the steps required to access prescribed medications. You’ll take an active role in swiftly moving insurance-related needs forward by following prior authorizations through completion, investigating coverage barriers, coordinating with patients, providers, and internal care teams, and proactively reaching out when direct communication can help clarify information or advance medication access. At Pixel, patient‑first care means making a complicated healthcare journey feel more informed, connected, and supported. As an important part of our patient care operations, you’ll help reduce uncertainty, remove insurance-related barriers, and ensure patients understand what comes next. The ideal candidate is highly organized, detail-oriented, and naturally persistent when working through complex insurance questions. They are comfortable navigating multiple systems, asking questions, following up, and taking ownership of issues through resolution. They communicate with empathy and professionalism, work well across teams, and understand that timely, proactive outreach can make a meaningful difference in a patient’s ability to access treatment. What You’ll Do Conduct comprehensive benefits analysis, including pharmacy and medical benefits, deductibles, copays, coinsurance, out‑of‑pocket responsibility, coverage limitations, exclusions, and applicable lifetime maximums. Perform and manage prior authorizations and pre‑certifications for prescribed medications, including submission, follow‑up, status tracking, and coordination of required supporting information. Review payer requirements and established authorization criteria to identify the information and documentation necessary to complete prior authorization requests. Investigate rejected or failed pharmacy claims and help resolve coverage restrictions, refill limitations, network requirements, and other insurance‑related barriers. Identify insurance‑preferred or mandated specialty pharmacies and coordinate appropriate routing when required by a patient’s plan. Identify and verify available manufacturer programs, copay assistance, discounts, and other patient financial assistance opportunities. Coordinate with patients, providers, referring clinics, pharmacists, and payer representatives to obtain insurance information, medical records, pharmacy benefit details, and other required documentation. Monitor prior authorizations through completion and proactively follow up on pending, incomplete, denied, or unresolved requests. Assist with authorization denials and appeals by gathering and routing required documentation to the appropriate clinical or operational team members. Provide patients with clear and accurate information regarding insurance coverage, estimated out‑of‑pocket responsibility, authorization status, and medication‑access requirements. Proactively reach out to patients by phone or other established communication channels when additional information, an update, or direct support can help resolve a barrier or advance medication access. Communicate authorization updates, denials, additional information requirements, and coverage changes to pharmacists and other care team members. Maintain accurate and thorough documentation of benefits findings, prior authorization activity, claim activity, patient interactions, and account information. Escalate clinical questions or concerns to a pharmacist or other appropriate licensed clinician. Collaborate with front‑of‑house and patient care teams to resolve more complex insurance and coverage questions and support a seamless patient experience. Protect patient information and maintain compliance with HIPAA and organizational confidentiality standards. What We’re Looking For Required Qualifications High School Diploma or equivalent, required. Minimum two years’ experience in insurance verification, prior authorizations, benefits analysis, pharmacy operations, healthcare reimbursement, patient access, or a related healthcare setting. Active pharmacy technician registration in New Jersey. Eligibility and willingness to obtain pharmacy technician registrations in Texas, and additional states as business needs require. Experience performing prior authorizations and conducting benefits verification or benefits analysis. Strong knowledge of insurance processes, including prior authorizations, pharmacy and medical benefits, claim adjudication, network requirements, and patient financial responsibility. Familiarity with EMR systems, pharmacy platforms, payer portals, and other insurance or healthcare technology. Excellent attention to detail and the ability to accurately manage a high volume of detailed patient and insurance information. Strong organizational and time‑management skills with the ability to prioritize urgent needs and proactively move work forward. Strong written and verbal communication skills with a compassionate, patient‑centered approach. Strong problem‑solving skills and a willingness to investigate issues through resolution rather than simply identifying the problem. Ability to work independently while collaborating effectively with patients, pharmacists, providers, and cross‑functional team members. Ability to thrive in a fast‑paced environment while maintaining accuracy, professionalism, and attention to detail. Proficiency with Microsoft Office Suite, Teams, and Excel. Knowledge of HIPAA requirements and a commitment to maintaining patient confidentiality. Preferred Qualifications Experience in specialty pharmacy, fertility services, or another environment involving high‑cost or complex medications, highly preferred. PTCB Certification. Experience conducting detailed pharmacy and medical benefits analysis. Experience resolving rejected pharmacy claims and complex insurance coverage issues. Familiarity with manufacturer copay assistance, financial assistance programs, and specialty pharmacy network requirements. Experience working in a fast‑paced, technology‑enabled pharmacy environment. Bilingual skills are a plus. Why You’ll Love Working Here You’ll join a collaborative team that believes exceptional patient care begins with exceptional people. As a growing healthcare startup, we’re building something meaningful together – finding new ways to support patients while empowering our team members to contribute ideas, drive improvements, and make a lasting impact. Our Values At Pixel, our values shape how we work with patients, partners, and one another: Empathetic – Our roots are in traditional pharmacy care, where personal interactions and relationships matter, and we bring warmth and sincerity to all relationships, both internal and external. Disruptors – We will never settle. We believe in pushing the limits of what’s possible to serve our patients better. Confidence – With 100+ years of combined experience, our professionals are confident in making the patient experience and journey easier. Positivity – Our professionals are here to share their experience and help create an empowered, safe, and successful patient care journey. Driven – We’re allies for our patients, providers, and pharmacy partners. Our supportive nature fosters honest, warm, and meaningful relationships. Transparency – We are committed to openness, trust, and clarity in all aspects of patient care and business. #J-18808-Ljbffr Pixelcare