Benefits Verification Specialist

Spectraforce Technologies, Inc.; Raleigh (NC); A distancia; USD 25.000 - 41.000; Jornada completa

Descripción de la vacante

Spectraforce Technologies, Inc. is seeking a Benefits Verification Specialist to verify patient benefits by contacting insurance companies.

The role involves documenting coverages, cost shares, and access options while coordinating with internal teams to resolve any missing information. Under supervision, you will handle prior authorizations and related duties, ensuring accurate data entry and timely processing in a remote, contract-based setting lasting 3+ months.

Formación

• High school diploma or GED required; 2+ years directly related and progressively responsible experience preferred.
• A two-year associate's degree can substitute for two years of experience.
• Experience with Windows-based data entry, typing, and standard software is expected.

Responsabilidades

• Review patient insurance information to complete benefit verification.
• Triages cases with missing information to appropriate program associate.
• Verify patient benefits and document specifics for payer plans (coverage, cost share, access).
• Identify restrictions and ways to expedite patient access.
• Document and initiate prior authorization, claims appeals, etc.
• Perform quality review of work before finalizing records.
• Report reimbursement trends/delays to management.
• Handle related duties and special projects as assigned.

Conocimientos

Data entry

Outlook

Word

Excel

Interpersonal skills

Problem solving

Attention to detail

Communication

Insurance verification familiarity

Customer service

Educación

High school diploma or GED

Two-year associate's degree or equivalent

Descripción del empleo

Title: Benefits Verification Specialist

Location: Remote

Duration: 3+ months

Shift: 8:30AM- 5:30PM EST with occasional late shift 11:00AM-7:00PM EST.

Training Hours: 8:30AM- 5:30PM EST

Position Summary

Under general supervision of an Operations Manager, the Benefits Verification Specialist will contact insurance companies to verify patient specific benefits for programs we administer. The Benefits Verification Specialist will ask appropriate questions regarding patient's benefits and complete data entry and/or appropriate forms to document patient's benefits coverage.

Primary Duties and Responsibilities

1. Reviews all patient insurance information needed to complete the benefit verification process.
2. Triages cases with missing information to appropriate program associate.
3. Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.
4. Identifies any restrictions and details on how to expedite patient access.
5. Could include documenting and initiating prior authorization process, claims appeals, etc.
6. Completes quality review of work as part of finalizing product.
7. Reports any reimbursement trends/delays to management.
8. Performs related duties and special projects as assigned.

Experience and Educational Requirements

High school diploma or GED required. Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate's degree program, technical vocational training, or equivalent combination of experience and education. Two years (2) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement.

Minimum Skills, Knowledge and Ability Requirements

1. Proficient Windows based experience including fundamentals of data entry/typing
2. Working knowledge of Outlook, Word, and Excel
3. Strong interpersonal skills and professionalism
4. Independent problem solver, good decision maker, and robust analytical skills
5. Strong attention to detail
6. Effective written and verbal communication
7. Familiarity with verification of insurance benefits preferred
8. Attention to detail, flexibility, and the ability to adapt to changing work situations.
9. Strong customer service experience

Work Environment

The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

The noise level in the work environment is consistent with an office setting.

Physical and Mental Requirements

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.
2. Visual requirement is for close vision, distance vision, peripheral vision and ability to adjust focus.
3. 75% or more time is spent looking directly at a computer.
4. Ability to deal with stressful situations as they arise.