Pharmacy Benefit Specialist

Insight Global is seeking a Pharmacy Benefits Specialist to support a pharmacy operations team by ensuring proper authorizations are in place and helping to calculate patient out-of-pocket costs prior to medication dispensing. This person will manage a high volume patient queue and work cross-functionally with both pharmacy and financial services partners to keep patient cases moving, support clean billing, and assist with payer audits and operational needs as required.

Day-to-Day Responsibilities
-Verify active and billable insurance coverage using Waystar (or similar platforms) and internal systems/resources.
-Assist the pharmacy site team with processing/shipping workflows when applicable.
-Confirm that current and viable authorizations are on file for all billable products and services prior to dispensing.
-Calculate and communicate patient out-of-pocket responsibility prior to medication fulfillment/shipment.
-Proactively communicate status updates and issues to appropriate departments to determine when to proceed or escalate.
-Support completion of external payor audits by gathering required data and documentation as needed.
-Maintain patient privacy and confidentiality and ensure work aligns with regulatory requirements and internal policies.
-Complete assigned documentation accurately and on time; contribute to a team-first environment by sharing knowledge and supporting peers.
-Go into the patient queue and take the insurance information provided from the initial patient intake calls and enter it into Wayfair and/or Availity to ensure the patients insurance is still active and it's not in grace period, etc. -- need to be able to identify patient current balance, their specific insurance coverage, & relay costs covered by insurance as well as the patient's out of pocket cost.
Insurances they take: commercial payers, managed care payers, medicare advantage plans, medicare, etc. (all insurances)

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

• Self-starter that is detail oriented with the ability to multitask & make accurate, fast decisions
• Active Maryland Pharmacy Technician license (open to obtaining additional state licenses if needed)
• Experience verifying active and billable insurance coverage using Waystar, Availity, or similar platforms
• Ability to confirm and accurately verify 40-60 patients/day
• High school diploma or GED
• Comfortable using Microsoft Suite (Outlook, Excel, basic systems)
• Personable and professional on patient/insurances phone calls

• Previous specialty or infusion pharmacy experience
• Pharmacy Technician certification (PTCB or NPTA)

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.