Insurance Verifications I (Bi-Lingual)

Axium Healthcare Pharmacy, Inc.; Florida; On-site; USD 25,000 - 36,000; Full time

Job summary

Axium Healthcare Pharmacy, Inc. is seeking an Insurance Verification Specialist to support our specialty pharmacy operations.

You will verify insurance coverage, determine if prior authorization is required, and input patient data to ensure accurate claims processing. The ideal candidate has 2+ years of experience with medical insurance verification, benefits investigations, and prior authorizations, plus excellent communication and teamwork skills.

Qualifications

• Must have experience working with specialty infusion or pharmaceuticals.
• 2+ years of experience with medical insurance verification, benefits and eligibility investigations.
• Experience with submitting and obtaining prior authorizations.
• Knowledge of medical terminology.
• Excellent communication skills.
• Ability to multitask and work cooperatively.

Responsibilities

• Verify insurance for limits and parameters of policy.
• Determine if prior authorization of pre-cert is necessary and work accordingly.
• Input required patient data information into system.
• Create verification note explaining benefits and other necessary information.
• Process/reverse online claims as required.
• Gather appropriate documentation, fill out necessary forms and submit authorization requests.
• Process/reverse online claims as required and interpret/resolve PBM rejections.
• Input required authorization information into system(s).
• Collaborate with Jr. & Sr. Team members to ensure appropriateness of the prior authorization documentation and completeness of questionnaires.
• Elevate difficult verification issues when unable to resolve timely.
• Provide interdepartmental support as needed.
• Possessing “critical
• out of the box
• thinking
• The ideal candidate will also possess the following qualities:
• Ability to trouble shoot prior authorization issues.
• Excellent internal customer service and communication skills.
• Excellent external customer service and communication skills.
• Understanding of how to refer patients to various assistance programs as needed based on patient’s insurance coverage, or lack thereof.
• Understanding of insurance and insurance related coding to support claim processing
• Understanding of how to identify possible new contracting opportunities.
• Understanding of government payors including Share of Cost
• Understanding of how to requests vacation/lost/damage overrides from the insurance carriers when warranted

Skills

Medical terminology

Insurance verification

Benefits eligibility

Prior authorization

Communication skills

Multitasking

Team collaboration

Job description

At Axium Healthcare Pharmacy, Inc., we believe in a better quality of life for patients and their healthcare partners when treating and managing the most complex conditions. We believe in relationships that make life easier, and where a helping hand and better clinical, economical, and overall health outcomes are always within reach, 24 x 7 x 365. Our mission is simple. We aim to partner with and guide our patients to their best possible outcomes. Our longstanding vision is to help our patients and healthcare providers reach and create a better path to treating and managing complex conditions, making their lives easier and giving them hope for a healthier future. Specialty pharmacy is not a new concept. In fact, Axium did not invent specialty pharmacy. But, we did invent a better way to do it. We do it through a combination of clinical expertise, nationwide reach and the delivery of committed, caring, unmatched service and support for everyone, every time with no excuses. And, we’ve been doing it for years. We invite you to ask us what we can do for you. Our answer to you will almost always be: “Yes, we do.” Established in 2000 and based in Lake Mary, Florida, Axium is a nationwide clinical specialty pharmacy that makes life easier for those managing chronic disease and complex therapies by offering a helping hand and a better path to therapy management. We are licensed and permitted to operate in all 50 states and Puerto Rico, and specialize in providing patients, physicians, nurses, health plans, and other health care providers and partners with injectable and oral brand‑name products. Our focus is to “Improve outcomes one relationship at a time,” and we achieve this through an experienced patient care team of doctors of pharmacy, registered nurses, reimbursement specialists, and dedicated patient care coordinators; all of whom deliver the highest level of comprehensive care and clinical support with every prescription.

Job Description

Includes but is not limited to the following. Other duties may be assigned.

• Verify insurance for limits and parameters of policy.
• Determine if prior authorization of pre-cert is necessary and work accordingly.
• Input required patient data information into system.
• Create verification note explaining benefits and other necessary information.
• Process/reverse online claims as required.
• Gather appropriate documentation, fill out necessary forms and submit authorization requests.
• Process/reverse online claims as requiredo Ability to effectively interpret AND resolve PBM rejections.
• Input required authorization information into system(s).
• Ability to collaborate with Jr. & Sr. Team members to ensure appropriateness of the prior authorization documentation, and ensure completeness of the prior authorization questionnaires.o Ability to elevate difficult verification issues when unable to resolve timely.
• Supporting group and management efforts with a positive attitude
• Possessing “critical" and “out of the box" thinking
• Provides interdepartmental support as needed
• The ideal candidate will also possess the following qualities:
• Ability to trouble shoot prior authorization issues
• Excellent internal customer service and communication skills
• Excellent external customer service and communication skills
• Understanding of how to refer patients to various assistance programs as needed based on patient’s insurance coverage, or lack thereof.
• Understanding of insurance and insurance related coding to support claim processing
• Understanding of how to identify possible new contracting opportunities.
• Understanding of government payors including Share of Cost
• Understanding of how to requests vacation/lost/damage overrides from the insurance carriers when warranted

Qualifications

• Must have experience working with specialty infusion or pharmaceuticals
• 2+ years of experience with medical insurance verification, benefits and eligibility investigations required.
• Experience with submitting and obtaining prior authorizations
• Knowledge of medical terminology
• Excellent communication skills
• Professional, reliable and dedicated
• Ability to work cooperatively.
• Ability to multitask.

Additional Information

All your information will be kept confidential according to EEO guidelines.