Qureos Mentor

Advanced Rx Management

<div>Job Overview

The Medical Insurance Verification Specialist is responsible for completing the enrollment process for new Workers' Compensation patients by obtaining and verifying all information required to successfully bill the patient's initial prescription claim. This individual serves as the liaison between physician offices, injured workers, employers, insurance carriers, adjusters, nurse case managers, attorneys, and internal departments to ensure claims are set up accurately and efficiently.

This position plays a critical role in reducing billing delays, improving first-pass claim acceptance, and ensuring patients receive their medications as quickly as possible.

Position Objective

The Verification Specialist ensures every new Workers' Compensation patient is accurately enrolled and all required claim information is obtained before billing begins. By establishing complete and accurate patient records at the start of the process, this role helps reduce billing delays, improve reimbursement timelines, and support a positive experience for both patients and provider partners.

Essential Responsibilities
<ul><li>Complete the enrollment of all new Workers' Compensation patients.</li></ul>
<ul><li>Collect and verify all information required to establish a new Workers' Compensation claim.</li></ul>
<ul><li>Contact insurance carriers, employers, adjusters, physician offices, nurse case managers, attorneys, and third-party administrators (TPAs) to obtain missing or incomplete claim information.</li></ul>
<ul><li>Review documentation for completeness and accuracy before the claim is released for billing.</li></ul>
<ul><li>Research and resolve missing enrollment information in a timely manner.</li></ul>
<ul><li>Maintain detailed and accurate documentation within the pharmacy management system.</li></ul>
<ul><li>Work collaboratively with Billing, Collections, Prior Authorization, Customer Service, Clinical, and Operations teams to ensure a seamless patient onboarding process.</li></ul>
<ul><li>Identify and escalate complex enrollment issues that may delay claim processing.</li></ul>
<ul><li>Maintain HIPAA compliance and protect confidential patient information.</li></ul>
<ul><li>Meet established productivity, quality, and service expectations.</li></ul>

Qualifications
<ul><li>High school diploma or equivalent required; associate or bachelor&rsquo;s degree preferred.</li></ul>
<ul><li>Minimum of two years of experience in Workers' Compensation, medical billing, pharmacy, healthcare, or insurance.</li></ul>
<ul><li>Working knowledge of Workers' Compensation claims and insurance processes.</li></ul>
<ul><li>Experience communicating with insurance adjusters, TPAs, employers, and physician offices.</li></ul>
<ul><li>Strong organizational skills with exceptional attention to detail.</li></ul>
<ul><li>Excellent verbal and written communication skills.</li></ul>
<ul><li>Ability to prioritize multiple tasks and work independently in a fast-paced environment.</li></ul>
<ul><li>Proficient in Microsoft Office and healthcare software applications.</li></ul>

Preferred Experience
<ul><li>Minimum (2) years Workers' Compensation pharmacy experience.</li></ul>
<ul><li>Pharmacy revenue cycle experience.</li></ul>
<ul><li>Insurance verification experience.</li></ul>
<ul><li>Knowledge of medical terminology.</li></ul>
<ul><li>Experience working within pharmacy or healthcare management systems.</li></ul>

Key Performance Indicators
<ul><li>Average enrollment turnaround time</li></ul>
<ul><li>Number of enrollments completed per day</li></ul>
<ul><li>Enrollment accuracy rate</li></ul>
<ul><li>Time to resolve incomplete or missing claim information</li></ul>
<ul><li>First-pass billing readiness rate</li></ul>
<ul><li>Documentation quality</li></ul>
<ul><li>Productivity and quality standards</li></ul>
<ul><li>Internal and external customer satisfaction</li></ul></div>

Medical Insurance Verification Specialist

<div>Advanced Rx is a Pharmaceutical Services Company headquartered in Sunrise, Florida with team members throughout the United States. We provide physicians with the ability to provide their patients fast and convenient access to medications directly from the physician office or by mail. Our services directly impact patient convenience, care, and well-being at their personal physician&rsquo;s office. The Company is experiencing rapid growth as it expands its product offerings and customer base throughout the United States.

Due to our rapid growth, Advanced Rx is seeking a Customer Sales Specialist based in North Carolina or South Carolina.

The Customer Sales Specialists are responsible for driving revenue growth with existing accounts in an assigned territory. This role focuses on maximizing account profitability through upselling existing accounts with pharmacy and repack services, cross-selling the entire portfolio of services (in-office dispensing, repack pharmacy services, and mail order pharmacy). The ultimate goal is maximizing the accounts capture rate of patient prescription needs. This position reports to the VP of customer Sales &amp; Support.

Our line of products and services include Dispensary and Pharmacy services, retail and wholesale medication sales, and more.

General Requirements:
<ul>
<li>1-5 years sales experience in the Health Care, Pharmaceutical Industry or a similar Sales field.</li>
<li>Preferred experience in territory management. This role covers North Carolina, South Carolina, and Virginia.</li>
<li>Proven track record of success in sales and account management roles.</li>
<li>Strong understanding of the healthcare industry, preferably with experience in the pharmacy or medical device sector.</li>
<li>Excellent communication, presentation, and interpersonal skills.</li>
<li>Ability to build and maintain strong client relationships.</li>
<li>Proficient in CRM systems and other sales-related software.</li>
<li>Strong analytical, time-management and problem-solving skills.</li>
<li>Ability to work independently and as part of a team.</li>
</ul>
Primary Duties and Responsibilities:
<ul>
<li>Achieve and exceed sales targets for assigned accounts</li>
<li>Support distributors and sales leaders with the execution of account plans to maximize revenue and improve capture rate</li>
<li>Upsell existing pharmacy and repack services within accounts.</li>
<li>Prepare and deliver compelling presentations and product/service demonstrations.</li>
<li>Maintain accurate and up-to-date records of all sales activities.</li>
<li>Conduct quarterly account reviews with key stakeholders</li>
<li>Provide ongoing support and guidance to clients to maximize capture rate.</li>
<li>Troubleshoot and resolve client issues related to service delivery and program management</li>
<li>Identify and report on any competitor&rsquo;s inroads or positioning within existing accounts</li>
<li>Ensure clients operate in a legal and compliant fashion relative to clients in office dispensing activities. Provide guidance to clients on any issues or concerns.</li>
<li>Bachelor&rsquo;s degree in Business, Pharmacy, Nursing or related field preferred</li>
<li>Valid driver&rsquo;s license and clean driving record required</li>
<li>Ability to travel up to 75%</li>
</ul>
Compensation Package:

$75k base / $120k at 100% of quota with no cap on commission

Benefits:
<ul>
<li>Health, Vision and Dental insurance after 60 days of employment</li>
<li>FSA</li>
<li>PTO</li>
<li>401K plan matching</li>
<li>Holidays paid</li>
<li>Employee Anniversary program</li>
<li>Auto Allowance</li>
<li>Cell phone reimbursement</li>
<li>Referral program</li>
</ul>
Job Type: Full-time

Education:
<ul>
<li>Bachelor's (Preferred)</li>
</ul>
Experience:
<ul>
<li>Pharmaceutical sales: 1 year (Preferred)</li>
</ul>
Location:
<ul>
<li>North Carolina (Preferred)</li>
</ul>
Willingness to travel:
<ul>
<li>75% (Required)</li>
</ul>
Work Location: On the road</div>

(Territory Medical Sales) Customer Sales Specialist

Join Advanced Rx Management and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Advanced Rx Management

About Company

Medical Insurance Verification Specialist

(Territory Medical Sales) Customer Sales Specialist