Insurance Verifications I (Bi-Lingual)

Includes but is not limited to the following. Other duties may be assigned.

• Verify insurance for limits and parameters of policy.
• Determine if prior authorization of pre-cert is necessary and work accordingly.
• Input required patient data information into system.
• Create verification note explaining benefits and other necessary information.
• Process/reverse online claims as required.
• Gather appropriate documentation, fill out necessary forms and submit authorization requests.
• Process/reverse online claims as required o Ability to effectively interpret AND resolve PBM rejections.
• Input required authorization information into system(s).
• Ability to collaborate with Jr. & Sr. Team members to ensure appropriateness of the prior authorization documentation, and ensure completeness of the prior authorization questionnaires. o Ability to escalate difficult verification issues when unable to resolve timely.
• Supporting group and management efforts with a positive attitude
• Possessing “critical" and “out of the box" thinking
• Provides interdepartmental support as needed

The ideal candidate will also possess the following qualities:

• Ability to trouble shoot prior authorization issues
• Excellent internal customer service and communication skills
• Excellent external customer service and communication skills
• Understanding of how to refer patients to various assistance programs as needed based on patient’s insurance coverage, or lack thereof.
• Understanding of insurance and insurance related coding to support claim processing
• Understanding of how to identify possible new contracting opportunities.
• Understanding of government payors including Share of Cost
• Understanding of how to requests vacation/lost/damage overrides from the insurance carriers when warranted
• Must have experience working with specialty infusion or pharmaceuticals
• 2+ years of experience with medical insurance verification, benefits and eligibility investigations required.
• Experience with submitting and obtaining prior authorizations
• Strong computer proficiency
• Knowledge of medical terminology
• Excellent communication skills
• Professional, reliable and dedicated
• Ability to work cooperatively.
• Ability to multitask.

All your information will be kept confidential according to EEO guidelines.