Benefits and Authorizations Specialist Lead

Nira Medical; Poland; On-site; PLN 30,000 - 40,000; Full time

Job summary

A healthcare services provider in Poland is seeking a Benefits Specialist Lead to ensure patients receive coverage for medical and infusion services. Responsibilities include verifying patient insurance coverage, obtaining pre-authorizations, and providing financial assistance support to patients. Ideal candidates will have a high school diploma, 2-3 years of relevant experience, and knowledge of medical terminology and insurance concepts. The role requires strong organizational and critical thinking skills while working in a fast-paced environment.

Qualifications

• 2-3 years of experience in medical insurance verification and prior authorizations, preferably in infusion services.
• Knowledge of insurance terminology and approval types.
• Previous experience with coding systems is helpful.

Responsibilities

• Verify and document insurance eligibility for office visits and infusion services.
• Obtain insurance authorization for necessary services.
• Facilitate appeals for insurance denials and maintain knowledge of authorization requirements.

Skills

Medical insurance verification

Organizational skills

Detail-oriented

Critical thinking

Multi-tasking

Education

High school diploma or equivalent

Tools

Athena

J-codes

CPT and ICD-10 coding

Job description

Job Summary

The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.

Key Responsibilities

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
• Obtains insurance authorization and pre-certification for office visits and infusion services.
• Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
• Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
• Calculate and communicate patient financial responsibility.
• Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

Qualifications

• High school diploma or equivalent
• 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
• Knowledge of insurance terminology, plan types, structures, and approval types
• Previous experience with J-codes, CPT and ICD-10 coding
• Previous Athena use a plus, but not a requirement
• Knowledge of medical terminology and clinical documentation review
• Strong organizational skills
• Detail-oriented
• Ability to multi-task and work well in a fast-paced setting
• Critical thinking skills and decisive judgment