Insurance Verification Specialist

Job Overview

The purpose of this position is to help patients get access to the medications and therapies they need.

Role Summary

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 and navigating complex reimbursement issues. The position also provides support for prior authorizations for an assigned caseload and helps navigate the appeals process to access medications.

Responsibilities

• Ensure cases move through the process in compliance with company requirements and defined standards and procedures.
• Conduct benefit investigations by making outbound calls to payers to verify patient insurance benefit information.
• Navigate complex reimbursement barriers and seek resources to overcome them.
• Verify patient-specific benefits and document coverage, cost share, and access/provider options.
• Identify coverage restrictions and details on how 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, health care providers, and patients.