Specialist, Insurance I

About AbbVie
AbbVie's mission is to discover and deliver innovative medicines that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas: immunology, oncology, neuroscience, eye care, virology, women's health and gastroenterology, in addition to products and services across its Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com . Follow @abbvie on Twitter , Facebook , Instagram , YouTube and LinkedIn .

• Provide subject matter expertise on medical and prescription insurance coverage/verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities. Accurately document information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.
• Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.
• Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits. Obtain and confirm information to maintain Pharmacy Solutions' payor intelligence resources.
• Accurately transmit prescription test claims to verify prescription coverage. Identify, research, and request the addition of new health plan pay plans and verify the status of medical contracts from Accounts Receivable to assure business continuity for prescription processing requirements.
• Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.
• Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks, and is responsible for providing periodic progress reports on goals and metrics.
• Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review, guidance, and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
• Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and AbbVie.
• Perform additional tasks, activities, and projects as deemed necessary by management.

Qualifications

• High school diploma or GED equivalent required. Degree preferred.
• Meet Pharmacy Technician licensure and certification requirements by start date in accordance with the Illinois Pharmacy Practice Act.
• 1-3 years of work experience in a healthcare or reimbursement setting; call center preferred.
• Demonstrated strong, accurate technical skills. Must be detail oriented. Must have thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations.
• Proven leadership skills. Demonstrated ability to lead and participate within a team, manage multiple priorities and meet associated timelines while maintaining accuracy.
• Professional written and verbal communication skills required. Ability to maintain a positive service image at all times even when dealing with challenging issues and unsatisfied customers.
• Proven organizational and problem solving skills, elevating to management when appropriate.
• Skilled with the use of the Microsoft Office Suite and the ability to use and effectively learn and navigate other computer systems.

Significant Work Activities
N/A
Travel
No
Job Type
Experienced
Schedule
Full-time
Job Level Code
IC
Equal Employment Opportunity
At AbbVie, we value bringing together individuals from diverse backgrounds to develop new and innovative solutions for patients. As an equal opportunity employer we do not discriminate on the basis of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information gender identity or expression, sexual orientation, marital status, protected veteran status, or any other legally protected characteristic.