Trinity Health · 3 weeks ago
Revenue Cycle Specialist for Specialty Pharmacy, ONSITE
Fort Wayne, IN
Full-time
Onsite
New Grad, Entry LevelTrinity Health is a healthcare organization focused on compassionate, person-centered care. The Specialty Pharmacy Revenue Cycle Specialist is responsible for verifying patient insurance eligibility, managing prior authorizations, and handling medical billing and collections to ensure patient access to medication.
DeliveryHealth Care
Responsibilities
Performing the appropriate processes to obtain and verify patient insurance eligibility and benefits, prior authorizations as needed, schedule delivery of patient medication and collect patient co-pays
Performing investigation of benefits and eligibility by phone and/or internet to determine coverage choices the patient has to start therapy
Answering questions and providing information to patients and providers as it pertains to the patient’s pharmacy benefits
Determining if prior authorization is needed for the claim to be paid
Gathering appropriate documentation, completing necessary forms, and submitting authorization requests
Collaborating with Clinical Staff to ensure appropriateness of the prior authorization documentation and ensures completeness of the prior authorization questionnaires
Collaborating with Integrated Specialty Pharmacy Staff located in the Physician Practice in support of activities including but not limited to benefits investigation, prior authorization request and submission, overturning appeals, and enrolling patient in financial assistance programs
Managing the prescription referrals in a progressive order to ensure all new patients and providers receive communication within the timeframe stated in the policy and procedure
Escalating service issues arising from prior authorization request or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy
Communicating with the provider updating them on the continual status of the patient’s prescription order
Documenting all activities in the appropriate system for each contact made to the patient, provider, and insurance plan
Facilitating appeals process between the patient, physician, and insurance company by requesting denial information
Facilitating obtaining the denial letter from the insurance, patient, or physician
Collaborating with clinical staff to ensure all required information and documentation are obtained prior to appeal submission
Participating in quality improvement activities
Triaging all clinical calls to clinical staff
Contacting patients to schedule the delivery of their medication and collect patient copays at the time of scheduling
Submitting Medicare B claims
Submitting Major Medical claims (primary and secondary) as needed through the appropriate billing system
Performing third party collection activities on outstanding unpaid claims and document such activities as they occur
Following up on all patient and third-party collection activities as needed
Complying with all regulatory requirements, including HIPAA/HITECH
Performing other duties as needed and assigned by the manager
Maintaining a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior
Qualification
Required
Must possess a comprehensive knowledge of adjudicating prescription drug claims as normally obtained through experience working in a specialty, home infusion, hospital, or retail pharmacy preferred
Experience with adjudicating prescription claims, corresponding with insurance companies and processing payments, strongly preferred
Familiarity with specialty pharmacy products and operations preferred
Knowledge of home infusion, mail order pharmacy or general pharmacy operations is preferred
Knowledge of Microsoft office products, including Word, Excel, PowerPoint and other graphics or presentation software
Must understand how to interpret an Explanation of Benefits
Understands how to request vacation/lost/damage overrides from the insurance carriers when warranted
Experience with billing Medicare B and other major medical commercial insurance billing using HCPCS J-codes preferred
Knowledge of posting denials and processing payments from both third-party insurance companies and patients, as well as keeping a detailed record of said denials and payments in the appropriate accounts receivable system
Company
Trinity Health
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation.
Founded in 2000
10001+ employees
H1B Sponsorship
Trinity Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (9)
2024 (12)
2023 (10)
2022 (9)
2021 (7)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$0.02MKey Investors
Centers for Disease Control and Prevention
2025-10-17Grant· $0.02M
Leadership Team
Dan Drake
Trinity Health PACE President and CEO
Eileen Coogan
Pres/CEO Allegany Franciscan Ministries
Recent News
2026-01-16
Company data provided by crunchbase