Medical Insurance Verification Specialist

As a leader in our field, our mission is to provide quality infusion services to patients and medical practices, including a 24‐hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of our patients and the communities we serve. Service is always our highest priority; keeping the patients’ health & safety at the center of everything we do.

Position Overview:

The Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information. This specific position will be responsible for focusing on the Veterans Affairs (VA) Community Care Program. The idea candidate will have the ability to interpret benefit information, understand insurance terminology, and coordinate with insurance payers, VA Community Care providers and VA facilities to secure necessary documentation and approvals timely.

Position Responsibilities:

• Responsibilities include initiating, following up, and securing authorizations sent to third-party payors
• Review and confirm patient insurance details to ensure eligibility for services.
• Track and follow up on all pending authorizations within 7 – 14 days depending upon payer guidelines to expedite the claims process.
• Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patients
• Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in place
• Work closely with customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timely
• Verify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems
• Organize work to avoid lost revenue due to filing limitations
• Review and verify all insurance plans and confirm patient's eligibility and benefits specific to DME.
• Review and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented in HDMS / OnBase.
• Input the correct Payer Plan ID# and enter data into systems to ensure accurate billing for current and future services.
• Determine the extent of liability for insurance plans, coordination of benefits, and personal responsibility.

Requirements:

• Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.
• Minimum of 2 years' experience in a healthcare setting
• Proficient in interpreting medical insurance benefits and terminology
• Organizational skills
• Strong follow-up
• Good troubleshooting skills

The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:

• Strong work ethic
• Sound judgment
• Proven written and verbal communication skills
• Natural curiosity to pursue issues and increase expertise
• Pursue and design innovative analytical performance metrics
• The courage to promote and defend ideas and analyses
• Strives to make an impact on improving our business processes and results
• Exemplary honesty and integrity
• Ability to collaborate effectively and work selflessly as part of a team

Job Type: Full-time

Pay: $20.00 - $23.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you have a year or more experience in the medical field or working with medical insurance? If so, we are very excited to talk with you about this opportunity.

Work Location: In person

Salary : $20 - $23