Medical Benefits Specialist

Asembia is seeking a Medical Benefits Specialist for our organization. The incumbent is responsible for executing program requirements, managing daily workflow, providing accurate and complete data input, managing pre‑certifications and providing high levels of customer service. Work shifts may vary: The pharmacies operating hours are Monday through Friday from 8:00 a.m. – 11:00 p.m. (EST), and Saturday and Sunday from 8:00 a.m. – 8:00 p.m. (EST). Job Scope and Major Responsibilities Educating clients and their healthcare team on the components of their insurance coverage, including Medical and Prescription benefits. Research billing issues and contact insurance carriers to resolve claim issues. Advocating for patients/clients in the prior authorization process, including denials and appeals. Manage time‑sensitive task completion on referral and prior authorization submissions. Ability to interact professionally with not only internal matrix partners, but external contacts such as providers, insurance carriers, patients, and other stakeholders. Assist in monitoring trends and elevate trends to supervisor to determine actions necessary to improve service outcomes. Must have regular and predictable attendance and timely arrival at work schedule. Compliance with the provisions of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, as amended (“HIPAA”). Required Qualifications Bachelor’s degree, in lieu of degree, 5 years of experience in Member Services or Provider Services, or Claims. Prior experience in Member/Provider Prior Authorization/Appeal Services preferred. Knowledge of medical terminology. Knowledge of 3rd party payors, healthcare insurance and the prior authorizations process. Prioritize appropriately, and manage multiple tasks and job responsibilities. Exceptional writing, editing and proofreading skills. Strong verbal and written communication skills. Strong organizational, analytical and problem‑solving skills. High motivation and the ability to work independently. Working knowledge of MS Word, Excel, and Outlook. Ability to preserve confidentiality of protected health information (PHI). Possess and maintain professional demeanor and courteous attitude. Must have a valid Pharmacy Tech License. Asembia is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, gender identity and expression, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws. #J-18808-Ljbffr