Insurance Verification Specialist

Description:

Job Description

The Benefits Verification Specialist will contact insurance companies, on behalf of the physician’s office, to verify patient specific benefits. The Benefits Verification Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage.

Responsibilities/Essential Functions (other duties as assigned):

• Collects and reviews all patient insurance information needed to complete the benefit verification process.

• Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options according to Program specific SOPs.

• Verification process could include electronic validation of pharmacy coverage and medical eligibility.

• Identifies any restrictions and details on how to expedite patient access.

• Could include documenting and initiating prior authorization process, claims appeals, etc.

• Completes quality review of work as part of finalizing product.

• Reports any reimbursement trends/delays to supervisor.

• Performs related duties and special projects as assigned.

• Ability to work in a fast-paced office environment.

• Work requires focus, flexibility, and the ability to adapt to changing work situations.

• This position requires that the Associate be seated most of the day.

Additional Skills & Qualifications:

Education:

• High school diploma or GED minimally required. Two (2) + years directly related and progressively responsible experience and/or college degree.

• Specific experience in medical office administration, benefit verification, coding, claims processing or customer service at an insurance company a plus

• Broader experience/training may be considered in fields such as case management, social services and pharmacy technician.

• Familiarity with verification of insurance benefits a plus.

• Fundamental understanding of key payers including Medicaid, Medicare and private payers

• Strong customer service experience

Experience Level:

Expert Level

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