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AssistRx · 2 weeks ago

Copay Support/Claims Processing Specialist

Phoenix, AZ

Full-time

Hybrid

New Grad, Entry Level

$45K/yr - $52K/yr

0+ years exp

AssistRx is a company focused on revolutionizing healthcare by improving patient access to essential medications. The Copay Support/Claims Processing Specialist is responsible for managing inbound communications related to claims processing and providing support to patients and healthcare providers, ensuring smooth operation within the copay programs.

Health CareInformation Technology

No H1B

Responsibilities

Quality control of commercial copay programs

Collaborate with internal HUB teams on enrollment discrepancies (missing info and duplicates)

Partners with claim adjudication vendors ensure proper claims processing and data integrity

Monitor and remediate medical and pharmacy manual data entry errors

Serve as Subject Matter Expert for internal and external stakeholders on medical and pharmacy Copay claim adjudication issues and platform logic variations

Provide ongoing insights on specific program trends and system/process opportunities

Act as the primary point of contact for handling inquiries from prescribers, patients, external clients, and internal program team members

Subject Matter Expert on reviewing and processing of medical claims submitted for copay programs where the therapy is primarily processed through a medical benefit

Ensure proper CMS form and EOB is provided for each eligible item

Validate required elements for payment approval are present

Create manual medical reimbursement record for submission to finance

Review Directive Analytics against Net-Suite and make necessary corrections

Identify applicable programs and guide stakeholders through next steps for patient support

Accept inbound calls, team chats, and emails. Ensure one-call resolution for patients and providers

Communicate status updates across all patient support activities in a holistic, clear, and professional manner

Liaise with program-specific AssistRx resources to secure outcomes and resolve escalations

Maintain accurate documentation and ensure protection of patient and prescriber information

Qualification

Pharmacy Data ManagementContract Management SystemsMedical Claims ProcessingMicrosoft OfficePNC Card Platform

Required

High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience

Associate's Degree (AA) or equivalent from a two-year college or technical school, or six months to one year related experience and/or training, or equivalent combination of education and experience

Computer skills required: Contract Management Systems; Microsoft Office

Other skills required: Pharmacy Data Management (PDMI), PNC Card Platform