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.