Medical Benefits Specialist

Asembia • Livingston, NJ

11d

About The Position

Asembia is seeking a Medical Benefits Specialist to execute program requirements, manage daily workflow, provide accurate and complete data input, manage pre-certifications, and deliver high levels of customer service. The role educates clients and their healthcare teams about insurance coverage, including medical and prescription benefits; researches billing issues and contacts insurance carriers to resolve claim issues; and advocates for patients and clients through prior authorizations, denials, and appeals. The specialist manages time-sensitive referral and prior-authorization submissions, works with internal partners and external stakeholders, monitors trends, and escalates them to a supervisor to improve service outcomes. The role requires regular, predictable attendance, timely arrival, and compliance with HIPAA.

Requirements

• Bachelor’s degree, or five years of experience in Member Services, Provider Services, or Claims in lieu of a degree.
• Knowledge of medical terminology.
• Knowledge of third-party payors, healthcare insurance, and the prior-authorization process.
• Ability to prioritize appropriately and manage multiple tasks and job responsibilities.
• Exceptional writing, editing, and proofreading skills.
• Strong verbal and written communication skills.
• Strong organizational, analytical, and problem-solving skills.
• High motivation and ability to work independently.
• Working knowledge of Microsoft Word, Excel, and Outlook.
• Ability to preserve the confidentiality of protected health information (PHI).
• Professional demeanor and courteous attitude.

Nice To Haves

• Prior experience in Member/Provider Prior Authorization/Appeal Services.

Responsibilities

• Educate clients and their healthcare teams about medical and prescription insurance benefits.
• Research billing issues and contact insurance carriers to resolve claim issues.
• Advocate for patients and clients during prior authorization processes, including denials and appeals.
• Complete referral and prior-authorization submissions within time-sensitive deadlines.
• Interact professionally with internal partners and external contacts, including providers, insurance carriers, patients, and other stakeholders.
• Monitor trends and escalate them to a supervisor to determine actions that may improve service outcomes.
• Maintain regular and predictable attendance and arrive at work on time.
• Comply with HIPAA and its implementing regulations, as amended.

What This Job Offers

• Job Type: Full-time