The purpose of this position is to help patients get access to the medications and therapies that they need.
This role works directly with healthcare providers and insurance plans/payers to gather information about a patient's insurance and the coverage provided for a specific pharmaceutical product. The Insurance Verification Specialist supports healthcare providers by addressing questions regarding coding and billing, navigating complex reimbursement issues, and providing support for prior authorizations on an assigned caseload. The role also helps navigate the appeals process to access medications.
Key responsibilities include:
- Ensure cases move through the process in compliance with company requirements and defined standards and procedures
- Conduct benefit investigations by contacting payers to verify patient insurance benefit information and identify reimbursement barriers
- Verify patient-specific benefits and document coverage, cost share, and access/provider options
- Identify coverage restrictions and ways to expedite patient access
- Document and initiate prior authorization processes and claims appeals
- Report reimbursement trends or delays in coverage to management
- Act as a liaison for field representatives, healthcare providers, and patients
Requirements & Qualifications
- In-depth understanding and experience with major medical and pharmacy benefit coverage
- 2 to 3 years of benefit investigation experience involving analysis and interpretation of insurance coverage
- 2 to 3 years of experience interacting with healthcare providers regarding health insurance plan requirements
- Excellent verbal communication skills and grammar
- Salesforce experience preferred
Benefits & Perks
- Medical, dental, vision, life, and short-term disability insurance
- Teledoc services for employees enrolled in medical insurance
- Supportive, progressive, fast-paced environment
- Competitive pay structure
- Matching 401(k) with immediate vesting
- Legal insurance
- Preloaded PTO: 100 hours upon employment, increasing to 140 hours upon anniversary
- Tenure vacation bonus at 3 and 5 years
- Hybrid schedule opportunity after training for many associates
- Career growth through internal promotion and development programs
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
4 weeks ago