Responsible for verifying insurance coverage and obtaining authorizations for scheduled biologics, infusion, and other injectable medications for new and established patients.
Key responsibilities include:
- Serve as the point of contact for medication authorizations and related insurance questions.
- Review, prioritize, and complete authorization and referral requests for medications.
- Verify specialty outpatient and inpatient insurance coverage, including primary and secondary benefits when applicable.
- Document covered and non-covered benefits, plan type, copay, coinsurance, deductible, and eligibility information.
- Notify Patient Financial Counseling of significant coverage gaps or high out-of-pocket costs before services are rendered.
- Coordinate drug copay assistance programs with the clinic and financial counseling team.
- Document authorizations and denied authorizations in the appropriate systems.
- Conduct clinical screening and provide medical information to insurance carriers to support authorization requests.
- Maintain knowledge of major insurance plans, medications, medical terminology, and coding practices.
- Educate clinical staff on patient insurance requirements and limitations.
- Communicate with patients regarding authorization and eligibility status.
- Coordinate appeals for medications deemed not medically necessary.
- Coordinate retroactive authorizations with medical staff, ancillary departments, and insurance plans as needed.
Requirements & Qualifications
- High school diploma or equivalent required; associate degree preferred.
- Minimum of 3 years of experience in a healthcare environment required.
- Experience as an LPN, Medical Assistant, or Pharmacy Technician preferred.
- Strong understanding of insurance verification, prior authorization, and medication-related workflows.
- Ability to manage deadlines, communicate effectively, and maintain attention to detail.
- No special certification or licensure required.
Benefits & Perks
- Comprehensive medical coverage
- Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)
- Paid time off and six paid holidays
- Dental and vision plans
- 403(b) retirement plan with employer contributions after two years
- Wellness incentives up to $200 annually
- Tuition reimbursement up to $5,250 annually
- Child care assistance via FSA with employer contribution
- Public Service Loan Forgiveness (PSLF) eligible employer
- Employer-paid disability and life insurance
- Optional voluntary benefits
- Local service and RTD bus pass discounts
Location
Denver, Colorado, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 months ago