Talent.com
Pharmacy Benefits Specialist I

Pharmacy Benefits Specialist I

AmeriPharmaLaguna Hills, CA, US
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Job Description

Job Description

Salary : $30-$33 Hourly, DOE

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharmas Benefits

  • Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
  • Great pay and general compensation structures
  • Employee assistance program to assist with mental health, legal questions, financial counseling etc.
  • Comprehensive PTO and sick leave options
  • 401k program
  • Plenty of opportunities for growth and advancement
  • Company sponsored outings and team-building events
  • Casual Fridays

Job Summary

The role supports the Patient & Revenue Retention Manager in the financial review process, ensuring cost-effectiveness by analyzing new referrals, existing patients health plan fee schedules, and other reimbursement databases. Key responsibilities include evaluating payer reimbursement methodologies, reviewing patient insurance benefits, and educating patients about available drug brands and copayment assistance programs. This position is designed to enhance patient onboarding and ongoing care by ensuring new and existing patients are informed of all available healthcare benefit options.

Schedule Details

Location : On-Site (Laguna Hills, CA.)

Hours : Monday-Friday 8 : 30 AM - 5 : 00 PM

Duties and Responsibilities

  • Assist with the reimbursement review and determination process within specialty operations.
  • Review new referrals to ensure cost-effectiveness based on payer fee schedules and / or contracted rates, utilizing both In / Out-of-Network benefits from the patients health plan.
  • Generate ad-hoc reports on profitability, cancellations, and other relevant categories.
  • Educate and guide patients on AmeriPharma's products and services, including financial assistance options when applicable.
  • Provide clear explanations of healthcare insurance benefits, including coverage details, copayments, deductibles, and network restrictions.
  • Accurately document patient interactions, insurance details, and other relevant information in the electronic health record (EHR) system.
  • Required Qualifications

  • Strong patient care and customer service skills.
  • Strong business acumen, problem-solving, and analytical skills.
  • Knowledge of medical and pharmacy reimbursement methodologies.
  • Familiarity with various types of health insurance benefits and patient access / copayment assistance programs in the marketplace.
  • Education and Experience Requirements

  • Associate's degree.
  • Minimum of 2 years of experience in specialty pharmacy setting
  • Minimum of 2 years of experience with payer reimbursement methodologies within the healthcare revenue specialty reimbursement industry; experience with Medicare Part B & D is preferred.
  • AmeriPharmas Mission Statement

    Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

    Physical Requirements

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and / or move up to 20 pounds and occasionally lift / or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

    EEO Statement

    The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP / EEO employer.All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.

    serp_jobs.job_alerts.create_a_job

    Benefit Specialist • Laguna Hills, CA, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Senior Health & Benefits Consultant

    Senior Health & Benefits Consultant

    Marsh McLennanIrvine, CA, US
    serp_jobs.job_card.full_time
    Senior Health & Benefits (H&B) Consultant.We are seeking a talented individual to join our Health & Benefits team at Mercer. This role will be based in Irvine or Los Angeles CA.This is a hybrid role...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Insurance Benefits Specialist- 100% Remote

    Insurance Benefits Specialist- 100% Remote

    Global EliteSanta Ana, CA, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Insurance Benefits Specialist- 100% Remote.Now is the best time to join full-time remote completely work from home.All benefits representatives start at entry level and move up! Suggested schedule ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Physician Biller II

    Physician Biller II

    Currance IncIrvine, CA, US
    serp_jobs.job_card.full_time
    We are hiring in the following states : .AR, AZ, CA, CO, CT, FL, GA, IA, IL, MN, MO, NC, NJ, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI. Candidates who meet the minimum qualifications will be required to ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medicare Representative

    Medicare Representative

    CCG Adelante Insurance ServicesCity of Industry, CA, US
    serp_jobs.job_card.full_time
    Job Posting : Medicare Sales Representative.Location : Flexible / field Sales.Salary : Competitive + Commission.Are you passionate about helping others and making a difference in your community? We...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Provider Navigator

    Provider Navigator

    Child Care Resource CenterSan Bernardino, CA, United States
    serp_jobs.job_card.full_time
    CCRC prides itself as a workplace of choice for passionate talent, driven by our mission to cultivate child, family and community well-being. Whether the position works directly with the public or s...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Access Rep / Admitting / Full-time Days

    Patient Access Rep / Admitting / Full-time Days

    KPC GLOBAL MEDICAL CENTERS INC.Menifee, CA, US
    serp_jobs.job_card.full_time
    Under supervision, to admit and register patients, coordinate financial aspects of the patient’s hospitalization, cashiering and to do other related work required. Any combination of education...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    PRN- Patient Recruitment Specialist (Pasadena, CA) •

    PRN- Patient Recruitment Specialist (Pasadena, CA) •

    Profound Research LLCPasadena, California, United States, 91101
    serp_jobs.job_card.full_time
    Profound Research seeks to drive clinical innovation by partnering with community physicians to offer clinical research as a therapeutic option to their patients. Profound enables providers with the...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    Life Insurance Benefits Representative

    Life Insurance Benefits Representative

    American Income Life : AOOrange County, CA, US
    serp_jobs.job_card.full_time +1
    serp_jobs.filters_job_card.quick_apply
    After a record-breaking year with $21 million in sales and 46% growth year over year we have decided to open up FULL TIME AND PART TIME additional positions for 2025. If you are hard-working, motiva...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Job Patient Services Representative - Lead

    Job Patient Services Representative - Lead

    Vista Community ClinicOceanside, CA, US
    serp_jobs.job_card.full_time
    Vista Community Clinic is a private, non-profit, multi-specialty outpatient clinic providing care in a comprehensive, high quality setting. Located in San Diego, Orange and Riverside counties, we wo...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Admitting Representative

    Admitting Representative

    Seton Medical CenterSan Gabriel, CA, US
    serp_jobs.job_card.full_time
    Patient Registration Specialist.Under general supervision and guidelines, obtains and verifies financial sponsorship, patient demographics, and clinical information. Utilizes skills and knowledge of...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Provider Relations Rep

    Provider Relations Rep

    Government JobsOrange, CA, US
    serp_jobs.job_card.full_time
    CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents.We are a public agency made up of compassionate leaders and professionals working tog...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Patient Access Liaison II - Access Center - Full Time 8 Hour Days (Non-Exempt) (Union)

    Patient Access Liaison II - Access Center - Full Time 8 Hour Days (Non-Exempt) (Union)

    University of Southern California (USC)Alhambra, CA, US
    serp_jobs.job_card.full_time
    Serves as primary point of contact for access to USC academic medical centers and USC Health Sciences Campus.Answers, screens and directs incoming and outgoing telephone calls, electronic messages ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Provider Recruiter

    Provider Recruiter

    TEKsystemsSan Dimas, CA, United States
    serp_jobs.job_card.full_time
    This position with be primarily remote with certain in office days for training and meetings!.Responsible for strategic and comprehensive physician recruitment in accordance with the needs and goal...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Medical Biller Sleep Apnea Program (FT / PT)

    Medical Biller Sleep Apnea Program (FT / PT)

    Aava International ConsultingRiverside, CA, US
    serp_jobs.job_card.full_time +1
    ZapZzz is a specialized sleep apnea treatment program with a mission of improving patients overall health and quality of life by providing advanced, patient-centered solutions for sleep apnea.We ar...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    ER Admitting Representative (Per Diem Nights)

    ER Admitting Representative (Per Diem Nights)

    ChocOrange, CA, US
    serp_jobs.job_card.full_time
    CHOC Emergency Room Admissions Representative.This admitting position in our ER is a per diem night shift.The admitting representative is responsible for assisting with patients and families in a p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Patient Services Rep (Admitting) - PT 8hr Varied

    Patient Services Rep (Admitting) - PT 8hr Varied

    KPC GLOBAL MEDICAL CENTERS INC.Santa Ana, CA, US
    serp_jobs.job_card.full_time +1
    Under the direction of the Admitting Manager provides organizational direction and vision to the Patient Access Department. Completes registration process with accuracy and courteously and in a time...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Healthcare Recruiter - Bilingual

    Healthcare Recruiter - Bilingual

    Maxim Health SystemsAlhambra, CA, US
    serp_jobs.job_card.full_time
    Maxim Healthcare is hiring for a Healthcare Recruiter in our Pasadena / Alhambra, CA Behavioral office!.Competitive pay & weekly paychecks. Health, dental, vision, and life insurance.Employee discount...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Admitting Representative (Per Diem)

    Admitting Representative (Per Diem)

    ChocOrange, CA, US
    serp_jobs.job_card.full_time
    At CHOC, we strive to be the leading destination of children's health by providing exceptional and innovative care.We are responsible for the overall health of our community's pediatric population ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days