Insurance Verifications Specialist — Prior Auth & Claims

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

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.