Medical Benefits Verification Specialist

Onco360•Woodridge, IL

8d•Remote

About The Position

The Medical Benefit Verification Specialist will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. They will ensure accurate insurance benefit documentation is made for specific IV and oral therapy orders.

Requirements

High School Diploma or GED.
Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
1+ years’ Medicare and Medical benefit verification experience
Medicare and Medical insurance and benefit verification
medical contracts
knowledge/understanding of Medicare, Medicaid, and commercial insurance
coordination of benefits
Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines
NDC medication billing
pharmacy or healthcare-related knowledge
knowledge of pharmacy terminology including sig codes
basic math and analytical skills
Intermediate typing/keyboarding skills.
Independent worker
good interpersonal skills
excellent verbal and written communications skills
ability to work independently
work efficiently to meet deadlines and be flexible
detail-oriented
great time-management skills

Nice To Haves

Associate degree or equivalent program from a 2-year program or technical school
Certified Pharmacy Technician (PTCB)
Specialty pharmacy experience
3+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience
Specialty Pharmacy experience
Medicare Billing Experience
Medical Authorization experience
Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)

Responsibilities

Verify Government payer (i.e. Medicare and Medicaid) eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services.
Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information and patient copays, deductibles and Out-of-Network responsibilities.
Determine optimal reimbursement based on medical plan and dispensing location, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information, doctors’ notes, assessments and lab reports.
Communicate succinctly and professionally both verbally and through written correspondence with Physician offices, nurses, insurance companies and patients as needed.
Exhibits a positive, courteous, respectful, and helpful attitude towards patients, team members, payers, and management. Contributes team effort by accomplishing related tasks as needed and other duties as assigned.
Research proper billing policies and procedures for all payer types, ensuring claims are processed correctly against industry and government standards and regulations, adhere to company compliance, integrity, patient privacy, and ethical billing practices.
Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.