Reimbursement & Benefits Representative

TEKsystems•Minneapolis, MN

3d•$23 - $25•Hybrid

About The Position

This program verifies benefits and works on prior authorization. Working directly with physician offices regarding coverage for surgery.

HS Diploma
2+ years of experience with medical insurance verification background
Knowledge of insurance benefit verification requirements, guidelines and policies, insurance plans requiring pre-authorization
Experience in a health care related industry.
Knowledge of commercial payers, Medicare and Medicaid and their benefit structure(s)

Act as an advocate for our customers as it relates to coverage.
Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for customers.
Obtain authorization, or pre-certifications required for patients to access coverage for Interventional Urology products.
Requests medical documentation from providers not limited to nurse case reviewers and clinical staff to build on claims for medical necessity.
Educates customers, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
Verifies that all products that require prior authorizations are complete. Updates customers and customer support team on status. Assists in coordinating appeals if required by insurance payer.
Maintains knowledge of the following: Medicare, Medicaid and Commercial payer requirements, guidelines, and policies.
Ability to communicate reimbursement and access topics concisely and clearly to office staff and/or patients
Work with customers if an exception to coverage is needed.
Answer incoming calls from customers / patients and about the insurance verification process using appropriate customer service skills and in a professional, knowledgeable, and courteous manner.
Other duties as assigned by the management team.