Insurance Verification Specialist

Description:

The primary function of the Insurance Analyst II is to work with patients, Health Care Providers (HCPs) and their staff through referral and by investigating patients’ insurance benefits and financial assistance opportunities, in addition to processing and monitoring prior authorizations to assist the patient in starting or continuing therapy. The position will be a subject matter expert in insurance billing, claims processing, and prior authorizations. You will liaise between departments, payors, and providers to comprehensively determine patients’ overall prescription coverage.

The Insurance Analyst II handles patient requests received by phone or electronically (fax, Humira Complete Pro, or other systems.) This position works collaboratively with other areas of the Pharmacy to maximize patients’ access to care.

Responsibilities:

• Provide subject matter expertise on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities. Accurately documents information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.
• Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.
• Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits. Obtain and confirm information to maintain Pharmacy Solutions’ payor intelligence resources.
• Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics. Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.
• Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review, guidance, and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
• Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information
• Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions
• Completes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews. Perform additional tasks, activities, and projects as deemed necessary by management.

Hours:

• Will be assigned an 8 hour shift between 7am-7pm CST

Additional Skills & Qualifications:

• 4 Years of Insurance Verification Experience (50 Daily) (REQUIRED)
• 4 Years of Prior Authorization Experience (50 daily)
• Claims resolution experience from beginning to end - must know how to work denials (REQUIRED)
• MUST have call center experience (REQUIRED)
• EMR experience
• Experience with Commercial and Government payers
• Comfortable taking 50 calls daily (Required)

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: 

▪  Medical, dental & vision 

▪  Critical Illness, Accident, and Hospital 

▪  401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available 

▪  Life Insurance (Voluntary Life & AD&D for the employee and dependents) 

▪  Short and long-term disability 

▪  Health Spending Account (HSA) 

▪  Transportation benefits 

▪  Employee Assistance Program 

▪  Time Off/Leave (PTO, Vacation or Sick Leave) 

Pay and Benefits

The pay range for this position is $18.00 - $23.80

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position will be accepting applications until Dec 28, 2024.

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.