Insurance Verification Specialist

Pharmacy Insurance Verification Specialist

Rx relief is seeking a detail-oriented Pharmacy Insurance Verification Specialist to join our team in Tampa, FL. In this role, you will manage the intake and onboarding lifecycle for incoming Workers' Compensation patients. You will gather, validate, and process all essential claim details required for seamless initial prescription billing.

Acting as a central communication bridge between healthcare providers, injured workers, insurance carriers, claims adjusters, nurse case managers, and internal teams, you will play a vital role in preventing billing delays, maximizing first-pass claim approvals, and ensuring patients receive their medications without interruption.

Key Responsibilities:

• Direct the initial intake process for all incoming Workers' Compensation patient accounts.
• Gather and verify accurate insurance, employment, and injury details needed to establish complete claim files.
• Communicate directly with insurance adjusters, Third-Party Administrators (TPAs), employers, physician offices, attorneys, and care managers to secure missing documentation.
• Review patient files and prescription data for accuracy and completeness prior to releasing claims for billing.
• Proactively research and resolve registration discrepancies or missing authorization info to minimize delay.
• Maintain precise, real-time records within the pharmacy management database.
• Partner closely with internal Billing, Collections, Prior Authorization, and Clinical operations teams to maintain a smooth patient intake workflow.
• Identify complex claim barriers and escalate them appropriately while strictly adhering to HIPAA and data privacy guidelines.

Qualifications & Requirements:

Minimum Education:

• High School Diploma or equivalent required.
• Associate or Bachelor's degree preferred.

Experience:

• 2+ years of professional experience in Workers' Compensation, pharmacy operations, medical billing, or health insurance verification.
• Solid understanding of Workers' Compensation claim lifecycles, pharmacy revenue cycles, and insurance verification workflows.
• Familiarity with medical terminology and pharmacy software platforms.
• Proven experience communicating with TPAs, insurance adjusters, employers, and medical offices.

Knowledge, Skills & Abilities:

• Exceptional organizational skills with a strong focus on accuracy.
• Clear, professional written and verbal communication skills.
• Capability to manage multiple priorities and adapt quickly in a fast-paced environment.
• Proficient with Microsoft Office Suite and specialized healthcare/pharmacy software applications.

Physical Requirements:

• This position primarily involves stationary desk work, operating computer systems, and handling phone communications. Candidates should be able to sit or stand for extended periods, perform repetitive desk duties, and occasionally lift or move up to 25 lbs.

Compensation / Pay Rate (Up to): $19.00 - $20.00 Per Hour