Lead Intake & Insurance Verification Coordinator

Centene Corporation

2d•Hybrid

About The Position

Centene is seeking a Lead Intake & Insurance Verification Coordinator to join their team. This role is crucial in transforming the health of communities by ensuring members have access to necessary services. The coordinator will be responsible for obtaining and verifying complete insurance information, managing the prior authorization process, assisting with copay assistance, and coordinating benefits. This position requires a proactive approach to managing workload, monitoring queues, and serving as a key point of contact for physicians' offices, payors, and special pharma accounts. The role involves documenting patient financial responsibilities, ensuring assignment of benefits, billing insurance companies, and identifying patient resources for reimbursement. The ideal candidate will be detail-oriented, possess strong communication skills, and be committed to Centene's mission of improving health outcomes.

Requirements

High school diploma or equivalent.
3+ years of medical billing, insurance verification experience, call center, and/or previous experience as a lead managing cross functional teams required.
Experience with payors and prior authorization requirements.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Qualified candidates must be able to work 12PM-9PM EST as well as overtime and weekend hours as needed.

Responsibilities

Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits.
Assist with managing the work load to ensure that referrals and orders are handled in a timely manner.
Monitor each queue through various reports and redistribute work as appropriate.
Serve as the point of contact for key physicians’ offices and coordinate referrals with the sales team during insurance verification process.
Serve as the point of contact or designated rep for contracted payors.
Serve as the point of contact or designated rep for special pharma accounts working with their HUB’s and collecting and documenting pharma-specific data in the system.
Obtain and verify insurance eligibility for services provided and document complete information in system.
Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies.
Collect any clinical information such as lab values, diagnosis codes, etc.
Determine patient’s financial responsibilities as stated by insurance.
Configure coordination of benefits information on every referral.
Ensure assignment of benefits are obtained and on file for Medicare claims.
Bill insurance companies for therapies provided.
Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures.
Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs.
Handle inbound calls from patients, physician offices, and/or insurance companies.
Performs other duties as assigned.
Complies with all policies and standards.