Medical Benefits Billing Verification Specialist

ConnectMed360 is seeking a Medical Benefits/Billing Verification Specialist for our Patient Services office located in Louisville, KY. This is a full-time, Monday through Friday position offering quarterly incentive bonuses and many growth opportunities.

This role involves connecting and caring for patients, providers, communities, and each other, supporting those battling cancer and rare diseases. The company values teamwork, respect, integrity, and passion.

ConnectMed360 creates customized patient support programs that connect manufacturers, providers, and patients to simplify the patient journey and deliver specialty medications and coordinated care quickly.

The Medical Benefits/Billing Verification Specialist is responsible for obtaining medical benefit verification and following up with beneficiaries to obtain correct payor information.

Major responsibilities include:

• Reimbursement experience for oncology or specialty injected/infused products in a buy and bill setting across all sites of care.
• Knowledge of payer landscape including state, federal, private third-party reimbursement issues, methodologies, and policies for physician-administered products.
• Comprehensive understanding of Medicare Parts A, B, C, D, and knowledge of commercial insurance reimbursement.
• Knowledge of billing and coding for 1500/1450 claim forms.
• Clearly communicating complex reimbursement and billing information to healthcare providers, their office staff, and/or patients.
• Educating provider offices on local and regional payer coverage policies, coding changes, and claims submission processes.
• Working with reimbursement call centers in support of patient access.
• Assisting offices to resolve rejected, denied, or underpaid claims.
• Completing accurate patient set up in operating systems.
• Performing full benefits verification on patients, investigating and verifying insurance policy terms and benefits.

Required qualifications:

• High school diploma or GED.
• 2+ years of pharmacy technician experience.
• Billing and coding knowledge.
• Current knowledge of applicable pharmacy laws, rules, and regulations.
• Registration/Certification with Board of Pharmacy as required by law.

Desired qualifications:

• Associate degree or equivalent in pharmacy or healthcare.
• 2+ years billing and coding experience.
• 6 months customer service experience.
• Payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience or related certifications.
• Certified Pharmacy Technician (PTCB).

Benefits include medical, dental, vision, 401k with match, paid time off and holidays, tuition reimbursement, and company-paid life and disability benefits.

Salary is from $25 per hour and up depending on experience.