Benefits Specialist

Company: Paragon Healthcare, Inc.
Location: Plano
Posted on: January 13, 2022

Job Description:

Great opportunity to join an award-winning national specialty infusion provider, Paragon Healthcare, based in Dallas, TX. This position supports an exclusive rare/orphan specialty product and will be part of our ParagonRare team dedicated to this product and program.This position is located at our home office in Plano, TX at 3033 W. President George Bush Fwy, 75075.The Benefits and Authorization - Rare Specialist ensures accurate and timely verification of benefits, submission of PBM claims, prior authorization requirements collection, submission and follow up, financial assistance enrollment and coordination with relevant internal Paragon Healthcare teams, prescribers offices, patients and caregivers. This position will be primarily dedicated to a given Rare/Orphan program in most cases for a single product / manufacturer.Job Specifications/Qualifications:

• High school diploma or equivalent (GED) required.
• Minimum of 1-2 years experience in the medical field, with a strong working knowledge of healthcare insurance, commercials/Medicare reimbursement, and managed care, in both pharmacy and major medical benefits and authorization process understood.
• Excellent interpersonal, communication, and organizational skills required.
• Ability to prioritize, multi-task, and problem solve.Major Responsibilities:
  • Responsible for delivering exceptional service to patients, providers, and team members, including open channels of communication, prompt response to inquiries and requests, and timely, accurate follow up of missing documentations.
  • Effectively communicate and escalate issues to the appropriate team members for patient-centric resolutions.
  • Maintain daily tasking work queue, quality assurance, and established productivity levels with minimal errors.
  • Obtain prior authorizations as required by payer, including procurement of needed clinical documentation by collaborating with the Patient Access team and clinical teams.
  • Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in patient profile.
  • Proactively work on prior authorizations that are due to be expired.
  • Provide assistance with reimbursement inquiry requests, including insurance benefit verification, prior authorization, denials and appeals, ad other reimbursement issues.
  • Identifies any restrictions and details on how to expedite patient access.
  • Performs research and analysis of patient account issues and strives to resolve problems timely and accurately.
  • Performs other duties and special projects as assigned.Work Standards:
    • Ability to work in a team setting, requiring cross-training of multiple functions.
    • Ability to prioritize, have excellent customers service and organizational skills with attention to detail, and the ability to work effectively in stressful situations.
    • Understands and adheres to all external accreditation review standards, applicable state, local, and Federal laws and/or regulations, including maintaining patient confidentiality through abiding by HIPAA laws/regulations.
    • Understands and adheres to all company policies and procedures.
    • Ability to work under strict guidelines, competing priorities, and immediate requests.
    • Establishes and maintains positive working relationships with internal and external customers as well as all company employees.
    • Displays a neat, clean, and professional appearance at all times.
    • Handles customer/patient complaints in a fair and empathetic manner.EducationRequired
      • High School or better

Keywords: Paragon Healthcare, Inc., Plano , Benefits Specialist, Other , Plano, Texas