About the job
Key Qualifications:
1. Proven Telephone Customer Service Experience
2. Background in Medical Office, Insurance, or Claims (preferred)
3. Solid Work History (minimum of 1 year at 3 of the last 5 employers or 2 of the last 3 employers)
Position Overview:
The Benefits Verification Specialist plays a crucial role in the healthcare process, assisting the project Team Coordinators and Management team by contacting insurance companies to confirm patient-specific benefits. This position involves asking relevant questions about patient benefits and accurately documenting the information gathered.
Core Responsibilities:
· Review and collect necessary insurance information from patients to facilitate the benefits verification process.
· Verify patient-specific benefits and meticulously document details for various payer plans, including coverage, cost-sharing, and provider access in accordance with program-specific SOPs.
· Engage in electronic validation of pharmacy coverage and medical eligibility as part of the verification process.
· Identify any restrictions on patient access and provide strategies to expedite the process.
· Document and initiate prior authorization procedures, claims appeals, and other related processes.
· Conduct quality reviews of completed work to ensure accuracy and compliance.
· Report any reimbursement trends or delays to the supervisor.
· Engage in related duties and special projects as assigned.
· Thrive in a fast-paced office environment requiring focus and adaptability.
· The role necessitates prolonged periods of sitting.
