Specialist, Insurance II

Lake County, Illinois
Apr 17, 2021
Required Education
High School or equivalent
Position Type
Full time
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 Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn.

  • Provide subject matter expertise on claim billing, insurance coverage/verification, prior authorization and appeal filing, and limited financial assistance opportunities such as (PAP, LIS, Independent Copay foundation, Copay Cards, etc.)- Communicate with insurance payors and providers to investigate pharmacy and medical benefits. Determine patient's financial responsibilities, quantity limits, and prior authorization or pre-certification requirements.
  • Perform QA on benefit verifications and review for reasonableness. Decide whether to reinvestigate or accept. Judge whether to escalate issues/concerns to management- Utilize the appropriate web tools to assess and determine patient eligibility and insurance benefits- Assist offices through the entire document/ information filing process for prior authorizations and appeals
  • Communicate 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.- Identify and populate the appropriate BV forms, templates and letters in accordance with investigation outcomes and forward to the patient and physician- Contact patient to inform them of benefits and estimated out of pocket expense.
  • Refer patients to AbbVie’s Humira Protection Plan, myHUMIRA support program, and other programs as appropriate.- Maintain and build relationships with insurance companies, key referral sources, Pharmacy Solutions’ PSPs, and other key members of Pharmacy Solutions operations team.- Meet performance standards in alignment with predefined metrics- Accurately transmit test claims to verify prescription coverage.
  • Accurately document all necessary information in all appropriate information systems.- Coordinate with other departments to assure timely claim payments.- Collect data, establish facts, draw conclusions, and solve problems- Participate in the coordination and assembly of patient and physician mailings
  • This position is accountable for the accurate and timely filing and processing of prescription claims, prior authorizations, and appeals in alignment with network pharmacy provider agreements to assure appropriate reimbursement for prescription drug claims. This position must diligently monitor prior authorizations and appeals working with the physician and office staff to assure a rapid turnaround resulting in procurement of the drug product for the patient.
  • This position will also be responsible for providing financial assistance alternatives and providing the patient with the most costeffective outcome. Finally, this position must understand and comply with all federal, state and local pharmacy laws and regulations, ethical billing practices, and HIPAA policies and guidelines.

  • High school diploma or GED equivalent required.Associate Degree preferred
  • Individuals must meet applicable Pharmacy Technician licensure and certification requirements within 15 days of their employment start date in accordance and compliance with the Illinois Pharmacy Practice Act.
  • Knowledge of applicable regulations and standards affecting Pharmaceutical Products (e.g. CFR 210/211, cGMP) specifically
  • 2+ years of relevant experience in a healthcare reimbursement and billing setting. Specialty Pharmacy experience desirable
  • Understanding and knowledge of commercial and major medical insurance programs, billing requirements, healthcare benefit investigation processes, prior authorization and appeal filings.
  • Government billing experience for filing Medicaid/Medicare claims, appeals, and denials
  • Accuracy, attention to detail, and fluency in the use of computers· Knowledge of Microsoft Office Program Suite and the Lotus Notes Suite including Excel, Word, and SharePoint.
  • Excellent verbal and written communication skills required.
  • Ability to manage large work volumes without loss of focus or accuracy
  • Works well as a team player in a complex high energy environment

Significant Work Activities
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)
Job Type
Job Level Code
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.