Insurance Benefit Specialist

Title: Insurance Benefit Specialist

Location: Durham, North Carolina(this job is fully remote)

Contract: 6 months

Important Note:

Strong experience/understanding of working with government insurance (specifically TRICARE).

Experience reviewing prior authorizations (PAs) and pre-certifications

Experience reading/understanding Explanation of Benefits (EOBs)

This role is NOT a heavy phone calling role, but the expectation is for the person to stay organized, be available to communicate with internal team, providers and patients as needed.

Ideally, looking for someone that sits in CST (work schedule 8-5pm). But can also consider people on EST that can work M-F 10-7pm EST.

Minimum length:6 months (high likelihood they will need this person for longer as they'll be supporting a long-term project)

Fully remote contract need (shooting for start date of 2/24/25)

Company is seeking an Insurance Benefit Specialist who is responsible for insurance and prior authorization review as well as data entry into the Company systems. The insurance review includes conducting eligibility and prior authorization verifications for coverage of the Company's early cancer detection test. This position requires outreach to providers and patients to remediate front end errors and missing information to ensure prompt payment from payers.

In this role you will:

Review incoming test requisitions that indicate a bill type of insurance to determine if Company has contracts in place to bill the payer.

Run eligibility verification for payers Company does have contracts with and determine if the patient has active coverage for their date of service.

Use various self-service systems to confirm if Prior Authorization was completed and active.

Update the accession with the correct insurance information and prior authorization prior to the test reporting to ensure the correct insurance information is sent to our third-party billing system.

Perform outreach to the patient or ordering physician if the information is invalid or missing to ensure accurate billing and reduce front end errors or denials.

Understand insurance requirements and processes pertaining to eligibility for lab benefits.

Display effective and professional communication skills and can navigate meaningful questions and resolve complex problems.

Document all interactions and calls within the case management system.

Abide by PCI, CLIA, CAP, HIPAA, and other state, federal, and regulatory guidelines.

Work independently and within a team setting.

Provide services in a high-volume work environment.

Adhere to SOPs pertaining to medical billing, customer service, and accessioning issue resolution.

Your background should include:

A Bachelor’s degree or an equivalent combination of education and experience.

A minimum of 2 years medical billing experience in the laboratory or in a closely-related field.

Strong communication skills with co-workers, managers and customers.

Strong organizational skills and meticulous attention to detail.

Ability to accept, integrate, and apply constructive feedback in a professional manner.

Ability to prioritize tasks and drive results with a high emphasis on quality.

Strong computer, internet, and software operation skills.