Insurance Verification Specialist (Tuesday - Saturday) - 500.00 Sign-On Bonus
About The Position
The purpose of this position is to help patients get access to the medications and therapies that they need. 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 Insurance 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
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
- 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
Benefits
- Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary.
- Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
- Many associates earn the opportunity to work a hybrid schedule after 120 days after training.
- We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
- If hired, receive a $750 referral bonus!
- Medical, dental, vision, life, & short-term disability insurance
- Teledoc services for those enrolled in medical insurance
- Supportive, progressive, fast-paced environment
- Competitive pay structure
- Matching 401(k) with immediate vesting
- Legal insurance
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
251-500 employees
