JOB TITLE: Senior Insurance Verification Specialist
The insurance verification specialist is responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by an individual’s health care provider. Responsible for entering patient benefit information into the system and verifying the existing information accurate. The Senior Insurance Verification Specialist acts as a lead, coordinating, and reviewing the work of the Insurance Verifiers.
- Conduct full medical and pharmacy Benefit Investigations
- Resolves more complex issues related to patient coverage/responsibility for services
- Verify and approve work of the Insurance Verifiers
- Create and set up provider groups in the system
- Submit Prior Authorization forms to the payer as needed
- Make outbound calls to Insurance Payers, Specialty Pharmacies to obtain patient benefits
- Process documents based on department guidelines in accordance with standards and performance indicators
- Maintains all patient confidentiality
- Other duties and responsibilities as assigned by supervisor based on the specific client contract.
SPECIFIC DUTIES AND RESPONSIBILITIES:
- Must have experience working with insurance companies and have extensive knowledge of different types of coverage and policies.
- Must have excellent multitasking skills.
- Must be very detail-oriented and organized to maintain accurate patient insurance records.
- Ability to focus and work quickly within a 24-hour turnaround for patient insurance information.
- Must work well with others as part of a team in a close environment.
- Authorization to work in the US without sponsorship.
- Ability to express ideas clearly in both written and oral communications
- Experience with pre-certification or pre-authorization
PHYSICAL AND TECHNICAL ENVIRONMENT:
- Ability to work at a desk in the office for long periods of time.
- Noise level in the work environment is moderate.
- Specific vision abilities required by this job include close vision and color vision.
- Ability to maintain focus under high levels of pressure/multiple priorities.
EEO CODE – eBluSolutions is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state or local law. eBlu Solutions is an Equal Employment Opportunity and Affirmative Action Employer.
- Three to five years’ experience in a health plan, facility, healthcare provider office or pharmaceutical industry
- Three to five years’ experience in a call center preferred
- Working knowledge of reimbursement (i.e. benefit investigation, prior authorization, pre-certification, letters of medical necessity)
- General knowledge of reimbursement and patient assistance programs and database elements and functionality; operational policies and processes
- Bachelor Degree or equivalent work experience
PREFERRED EXPERIENCE, SKILLS, AND ABILITIES:
- Knowledge of Medical Terminology preferred
- Working knowledge of drug reimbursement issues
- Understanding of Health Plan Medical Policies and Prior Authorization Criteria
- Knowledge of HCPCS, CPT and ICD-10 coding
- Strong computer skills required; preferably Microsoft Word or Excel software applications
- Data entry skills required
- Ability to resolve problems independently
- Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
- Ability to follow instructions
- Adaptable to changing priorities as needed
- Have exceptional attention to detail and excellent analytical, investigation, and problem-solving skills
- Ability to manage multiple priorities concurrently