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Medical CoPay Claims Processor at AssistRx. 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.. . . College degree is preferred or a high school diploma with equivalent combination of education and experience.. . Other skills required: . . . Previous work experience in Medical Reimbursement including HICF forms and EOBs.. . Comprehensive understanding of Explanation of Benefits and application of patient benefit including HCPCs level II and CPT codes.. . Processing claims and resolving denial instances. . Calculate patient responsibilities for copay reimbursement for services provided as outlined within the program business rules.. . Strong understanding of Government benefits such as Medicare, Medicaid, and Tricare.. . Documenting and reporting payment information.. . Professional level skills in computer use, including but not limited to Microsoft Office Suite, web-based applications, and keyboard skills.. . Demonstrated strong written and verbal communication skills with providers, patients and insurance companies.. . Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics.. . Problem solving skills.. . . COMPETENCIES:. . . Attendance/Punctuality.  - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.. . . Customer Service.  - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.. . . Dependability.  - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.. . . Professionalism.  - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.. . . Quality.  - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.. . . Teamwork.  - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.. . . Diversity. - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.. . . Ethics. - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Company Location: United States.