Insurance Specialist - Clinical Trials

City of Hope

4d•Onsite

About The Position

The Research Insurance Specialist is essential in the success of supporting clinical trials. The primary task is to verify insurance policy benefit information and obtain authorizations/pre-certifications for services not covered by the clinical trial study. The Research Insurance Specialist will verify with the clinical trial patient’s insurance provider if the incumbent has coverage to participate in the proposed trial. If approved, then using a clinical trial study coverage analysis, the research insurance specialist will determine for each upcoming appointment whether or not the upcoming service will be covered by the study sponsor or whether the service needs prior authorization to be covered by the patient’s insurance. The Research Insurance Specialist is responsible for obtaining timely authorizations/pre-certifications when needed for all services not covered under the study.

Requirements

High School Diploma
2 years of related experience
1+ years of healthcare experience working with insurance/authorizations

Responsibilities

Obtain Insurance Benefits Confirmation: Review billing grid/budget and compile list of all standard of care procedures associated to research. Verifies hospital and professional insurance policy benefits for clinical trial patients. The verification process includes: Telephone contact, Mail/Facsimile, On-line inquiry. Enters information concerning the policy benefits into the system and updates insurance information in the system.
Ongoing Authorization: Review billing grid/budget to determine if upcoming services require authorization and update in medical record. Request authorization extension or new authorizations for continuity of care for research as needed or when coverage changes and inputs updates into the system.
Customer Service: Ensure a high level of customer service by resource to patients and team members. Serve as a liaison between patients and support staff. Develop effective relationships with colleague, physicians, providers, leaders and other employees across the organization. Demonstrates genuine interest in helping our patients, providers and other employees by using excellent communication skills, being polite, friendly, patient and calm under pressure.