Full Time Hybrid Lead - Specialist, Patient Benefits

Altus Biologics•Pearland, TX

42d•Hybrid

About The Position

Altus Biologics is dedicated to every client and patient through its management of the administrative aspects of our physician's biologic therapy practices. Our clinical professionals and administration staff are experienced and achieve desired results. We have a team environment that is filled with motivated, hard-working, and joyful employees ready to help our physicians and patients. Altus fosters opportunities for development and would like to provide you a real chance to make a difference. The Lead Insurance Verification & Authorization Specialist is responsible for overseeing day-to-day operations related to insurance verification, prior authorizations, and patient access activities. In addition to performing verification and authorization tasks, this role provides guidance, training, and support to team members to ensure accuracy, efficiency, and compliance with payer requirements. The Lead acts as a resource and point of escalation for complex cases, while helping to streamline processes and ensure patients can begin treatment in a timely manner. Summary Verify patient insurance coverage prior to appointments, ensuring necessary procedures are covered. Obtain medical information, prior authorizations, PCP referrals, coordination of benefits, and cost-share details to facilitate treatment. Submit prior authorizations through payer-specific portals and vendors in a timely manner. Communicate with insurance companies, providers, pharmacies, and patients via portals, phone, and fax regarding insurance verification and benefit coverage. Monitor and follow up on pending insurance authorizations, documenting all interactions accurately in the medical record. Schedule and reschedule patient appointments as needed. Provide day-to-day guidance, mentorship, and training to insurance verification staff. Act as a subject matter expert and escalation point for complex verification or authorization cases. Assist in monitoring team productivity and quality, ensuring departmental goals and service standards are met. Collaborate with leadership to identify workflow improvements, streamline processes, and enhance the patient experience. Perform other related duties as assigned.

Requirements

High School Diploma or equivalent, or higher
2 or more years of insurance verification experience in a healthcare setting.
2 or more years experience of prior authorization processes, payer requirements, and coordination of benefits.

Nice To Haves

1 or more years of prior authorization or appeals experience in a healthcare setting.
1 or more years of experience in a lead or mentor role within patient access, insurance verification, or prior authorization teams.

Responsibilities

Verify patient insurance coverage prior to appointments, ensuring necessary procedures are covered.
Obtain medical information, prior authorizations, PCP referrals, coordination of benefits, and cost-share details to facilitate treatment.
Submit prior authorizations through payer-specific portals and vendors in a timely manner.
Communicate with insurance companies, providers, pharmacies, and patients via portals, phone, and fax regarding insurance verification and benefit coverage.
Monitor and follow up on pending insurance authorizations, documenting all interactions accurately in the medical record.
Schedule and reschedule patient appointments as needed.
Provide day-to-day guidance, mentorship, and training to insurance verification staff.
Act as a subject matter expert and escalation point for complex verification or authorization cases.
Assist in monitoring team productivity and quality, ensuring departmental goals and service standards are met.
Collaborate with leadership to identify workflow improvements, streamline processes, and enhance the patient experience.
Perform other related duties as assigned.