Insurance Verification, $16/hr, Remote
Posting ID: 7337516
- Responsible for verifying patient eligibility, coordinating benefits, running test claims and determining patient coverage/responsibility for services including, but not limited to primarily major medical insurance benefits verification, complex insurance plan verification and high volume PBM plans.The IVS needs to understand and work with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical, and PBM.Understanding the authorization process is a must. The IVS will also be responsible for the coordination of benefits investigation and partnering with patient assistance programs .May also assist with testing and implementation of new planned business.
* Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patients file.
* Verifies patient insurance coverage of medications, administration supplies and related pharmacy services through proper investigation into either major medical benefits (including Medicare) or pharmacy benefits.
* Facilitates and completes the prior authorization process with insurance companies and practitioner offices.
Completes a full Medical Verification for all medications, administration supplies and related pharmacy services.
* Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility.
* Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization and any other claim rejections.
* Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary. Places outbound calls to patients or physicians offices to obtain additional information needed to process the script or to notify of delay in processing script. * Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.
* 0- 2 years of insurance verification and/or pharmacy tech experience in using J-codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B&D billing, Major Medical, PBM, authorization; OR equivalent experience with AllianceRx Walgreens Prime;
* Experience in obtaining prior authorizations.
* Experience with the coordination of benefits, secondary insurance and/ or patient assistance programs.
* Experience with concepts of plan design and comfortable with the processes of overrides and rejections.
* Knowledge of and ability to explain concepts of medical benefit plan design (cost benefit, co-insurance, lifetime benefit, out-of-pocket maximum, using J-codes, CPT codes and Diagnosis codes/ route of admin /place of service).
* Experience in providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
* Problem solving experience.
* Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
* Willing to work mandatory extra hours, this may include evenings, weekends and/or hours outside of normal business hours.
Your success starts with the right career opportunity. Aerotek uses a people-focused approach to connect job seekers to incredible opportunities with leading organizations. Established in 1983, we've grown to become a consistent Best of Staffing® winner for talent satisfaction because of our dedication to exceptional service. Serving over 300,000 contract workers every year, we specialize in placing workers with engineering, scientific, professional and industrial skill sets. Aerotek is proud to offer competitive benefits, including contributory medical, dental and vision insurance, weekly pay, discounts on consumer goods and services and more.
Recruiter: Karmin Edgerly