Senior Benefits Investigation Specialist

Job Description

Job Description

Must Haves:

• HS Diploma or GED
• Computer Skills: Microsoft Office
• 2+ years of medical benefit investigation experience- buy and bill experience, prior authorization/ appeals
• Experience working with and explaining insurance coverage
• Experience working with all the major payors and DR offices -being able to make outbound calls
• Experience with patient assistance programs, financial assistance programs

Plus:

• Call Center Experience
• Experience with enrollment
• Pharmacy Experience
• Salesforce Experience

Day to Day

The Account Care Educator (ACE) serves as a single point of contact within the Patient Solutions department, supporting prescribers, patients, and field agents across an assigned territory. This role bridges communication between patients and support programs, identifying appropriate assistance programs, guiding next steps, and coordinating with other Assist resources to help patients achieve successful outcomes. ACEs handle inbound calls, aim for one-call resolution, and manage the reimbursement process, including insurance billing, claims submission, and denial resolution for both Medicare and commercial insurance. The role also carries responsibility for identifying and reporting adverse events and safety information in accordance with program requirements.

KEY RESPONSIBILITIES

• Single point of contact for questions and inquiries from the prescriber, patient, and field agent by territory.
• Identifies applicable programs and facilitates next steps. Holistically communicates the statuses of all patient support activities.
• Liaison with other program-specific Assist resources to secure outcomes for active patients.
• Accepts inbound calls for assigned territory or overflow of other territories and provides one call resolution support.
• Ensuresprotectionisinsured.
• Performs other related duties as assigned by management.
• Identify and report adverse events pursuant to program requirements.
• Identify, document, and report safety information.