Medical CoPay Claims Processor

Job Description

Job Description

DUTIES AND RESPONSIBILITIES :

• Processes medical copay claims in accordance with program business rules.
• Liaison with other program-specific AssistRx resources to secure outcomes for active patients.
• Performs outbound calls to inform and collect missing information.
• Ensures accuracy with attention to detail for copay claim processing and additional data collection.
• Performs other related duties as assigned by management.
• Perform daily reconciliation of batch postings, including automated / manual claim inputs.
• Analyze claims for accuracy based on insurance coverage, cost of goods, allowable amounts, and copays.
• Troubleshoot rejected claims and process prior authorizations or overrides.
• Maintain working knowledge of prescription plans and billing policies to ensure compliance and reimbursement.
• Monitor profitability of orders, manage claim queues (e.g., 3 & 5, 541, B queues), and adjust last events accordingly.
• Ensure timely claim submissions and adherence to adjudication and delivery windows.
• Coordinate with the Financial Assistance Department for additional funding when necessary.
• Promptly report reimbursement changes, underpayments, pricing discrepancies, or cost assistance needs.

Requirements

COMPETENCIES :

Benefits

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and / or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire