Benefits Verification Specialist - Specialty Pharmacy
About The Position
This role works directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. The Benefits Verification Specialist will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications. Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers Verify patient specific benefits and document specifics including coverage, cost share and access/provider options Identify any coverage restrictions and details on how to expedite patient access Document and initiate prior authorization process and claims appeals Report any reimbursement trends or delays in coverage to management Act as a liaison for field representatives, health care providers and patients Job Snapshot: Location: 9400 Southpark Center Loop, Orlando, FL 32819 Onsite Requirements: Onsite availability required Compensation: $19.00 - $23.00
Requirements
- In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
- 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage
- 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements
- Excellent verbal communication skills and grammar
Nice To Haves
- Salesforce system experience preferred
Responsibilities
- Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
- Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
- Identify any coverage restrictions and details on how to expedite patient access
- Document and initiate prior authorization process and claims appeals
- Report any reimbursement trends or delays in coverage to management
- Act as a liaison for field representatives, health care providers and patients
Benefits
- Paid Time off & Holidays: Preloaded PTO: 100 hours (12.5 days) PTO upon employment, prorated based on start date, increasing to 140 hours (17.5 days) upon anniversary. Plus 9 paid holidays annually.
- Work Hard, Play Hard: Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
- Full Benefits: Medical, dental, vision, life, & short-term disability insurance, Matching 401(k) with immediate vesting
- Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible. Tell your friends about us! If hired, receive a $750 referral bonus!
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
501-1,000 employees
