Remote Insurance Verification Specialist

Description

The Insurance Analyst provides best-in-class customer services to patients Health Care Providers HCPs and their staff through referral and call management by investigating patients insurance benefits and financial assistance opportunities in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy.

Responsibilities:

• Provide subject matter expertise on medical and prescription insurance coverage/ verification claim billing medication prior authorization and appeal filing and alternate financial assistance opportunities. Accurately documents information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone fax and/or the core pharmacy system as per established policies and procedures.

• Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.

• Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits. Obtain and confirm information to maintain Pharmacy Solutions payor intelligence resources.

• Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics. Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations taking ownership as needed.

• Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review guidance and resolution. Participate in quality monitoring and in identifying and reporting quality issues.

• Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information

Skills & Qualifications

Must Haves:

Insurance Verification Experience (2+ Years)

EPIC EMR Experience (2+ Years)

Call Center Experience (2+ Years)

The ability to work from 10:30AM CST - 7PM CST in a quiet, remote setting

Soft Skills:

1. Access to a secure and private location to work from daily. Access to fast and secure internet connection.

2. Maintain a professional dress code and appearance each day.

3. Balance attendance, understanding this is the number one reason agents contracts are not extended or termed early. This includes being on time for their shift and returning from lunch as well.

4. Must have thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorization and appeal filings, and specialty pharmacy operations.

5. Demonstrated ability to lead and participate within a team, manage multiple priorities, and meet associated timelines while maintaining accuracy.

6. Demonstrated strong, accurate technical skills.

7. Must be detail oriented.

8. Professional written and verbal communication skills required.

9. Ability to always maintain a positive service image even when dealing with challenging issues and unsatisfied customers.

Experience Level

Expert Level