Insurance Verification Specialist I

Axium Healthcare Pharmacy, Inc.; Irvine (CA); In loco; USD 52.000 - 72.000; Tempo pieno

Descrizione del lavoro

Axium Healthcare Pharmacy, Inc. is seeking a Verifier I to join our team and handle insurance verification across RX and major medical claims. You will gather and review documentation, communicate with departments, and ensure accurate reimbursement through effective prior authorizations and re-checks.

Responsibilities include processing verifications, completing PA questionnaires, and resolving PBM rejections while maintaining timely updates and cooperation with the patient care team.

Competenze

• Must have intermediate understanding of Insurance and Requirements/Restrictions.
• Attention to detail is essential for accurate verifications and documentation.
• Ability to interpret claim adjudication rejections and respond appropriately.
• Ability to initiate prior authorizations properly and track progress.
• Effective follow-up on cases to ensure timely processing.
• Basic math skills for calculations and reconciling patient data.

Mansioni

• Verifies insurance for RX and major medical claims in assigned areas.
• Completes Clinical Prior Authorization questionnaires accurately.
• Adjudicates primary and secondary insurances for prescription claims.
• Checks benefits and coverage to ensure appropriate reimbursement.
• Creates verification notes with benefits information for teams.
• Interprets and resolves PBM rejections efficiently.
• Maintains queues and supports team metrics with timely updates.
• Supports PAP and renewal processes as needed.
• Communicates delays and issues to patients, sales, and management.

Conoscenze

Attention to detail

Insurance requirements

Claim adjudication

Prior authorization initiation

Follow-up skills

Numerical/mathematical skills

Descrizione del lavoro

Axium Healthcare Pharmacy, Inc. is seeking a Verifier I to join our team and handle insurance verification across RX and major medical claims. You will gather and review documentation, communicate with departments, and ensure accurate reimbursement through effective prior authorizations and re-checks.

Responsibilities include processing verifications, completing PA questionnaires, and resolving PBM rejections while maintaining timely updates and cooperation with the patient care team.