Pharmacy Claims Representative 2 - Patient Financial Services

Become a part of our caring community   The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Use your business knowledge to help analyze data and provide financial support. Humana is seeking a Patient Finance Specialist that will work on the behalf of CenterWell Specialty Pharmacy customers, develop relationships with foundations and manufacturers, and provide internal customer support for the entire Pharmacy. Location: Remote Arizona or Ohio only Shift: Must be able to work an 8 hour shift between 8am and 8pm EST Monday-Friday. Overtime may be required during peak season. The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. Patient Finance Specialist detailed description: Source Patient Assistance programs and/or foundations to assist patients in meeting Out of Pocket responsibility Take inbound and make outbound calls related to Patient Assistant Programs, billing inquiries, and insurance verification Provide customer service (internal/external) Documenting case files with complete notes on work Complete special projects with varied and complex components as needed Use your skills to make an impact   Required Qualifications 1 or more years of customer service experience handling both incoming and outgoing phone calls in a professional setting  Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook Intermediate to High level of Windows Based system navigation Role Desirables Bachelor’s Degree in Finance, Accounting or a related field Pharmacy Technician Certification Previous Healthcare and/or Mail Order Pharmacy experience Pharmacy Claims experience Fluency in Spanish Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.   Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.   $40,000 - $52,300 per year   Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k)