Medical Benefits Specialist: Patient-Focused Claims

Asembia; Livingston (NJ); On-site; USD 55,000 - 85,000; Full time

Job summary

Asembia is seeking a Medical Benefits Specialist to join the Patient Support Center in Livingston, NJ. The role focuses on educating clients about insurance coverage, managing pre-certifications, and delivering high levels of customer service.

Responsibilities include resolving billing issues with insurance carriers, advocating for patients in prior authorizations, handling referrals, and ensuring HIPAA compliance while maintaining confidentiality and professional communication with providers

Qualifications

• Bachelor's degree or equivalent 5 years of experience in Member Services, Provider Services, or Claims.
• Experience in Member/Provider Prior Authorization/Appeal Services preferred.
• Knowledge of medical terminology and healthcare insurance processes.
• Ability to manage multiple tasks with strong organizational skills.
• Excellent writing, editing and proofreading abilities.
• Strong verbal and written communication skills.
• Independent and highly motivated with a professional demeanor.
• Proficiency in MS Word, Excel, and Outlook.
• Ability to handle PHI with confidentiality.

Responsibilities

• Educating clients and their healthcare team on insurance coverage components.
• Research billing issues and contact insurance carriers to resolve claim issues.
• Advocate for patients in the prior authorization process, including denials and appeals.
• Manage time-sensitive tasks for referrals and prior authorizations.
• Interact professionally with internal partners and external contacts.
• Monitor trends and escalate to supervisor to improve service outcomes.
• Maintain regular attendance and timely arrival at work.
• Ensure HIPAA compliance.

Skills

Medical terminology

Prior authorization experience

Written communication

Verbal communication

Organization

Problem-solving

Independence

PHI confidentiality

Attention to detail

Education

Bachelor's degree

5 years of related experience in lieu of degree

Tools

MS Word

Excel

Outlook

Job description

Asembia is seeking a Medical Benefits Specialist to join the Patient Support Center in Livingston, NJ. The role focuses on educating clients about insurance coverage, managing pre-certifications, and delivering high levels of customer service.

Responsibilities include resolving billing issues with insurance carriers, advocating for patients in prior authorizations, handling referrals, and ensuring HIPAA compliance while maintaining confidentiality and professional communication with providers