Prior Authorization & Insurance Verifications Specialist

Axium Healthcare Pharmacy, Inc.; Florida; In loco; USD 38.000 - 48.000; Tempo pieno

Descrizione del lavoro

Axium Healthcare Pharmacy, Inc. is seeking an Insurance Verification Specialist to support patient management and workflow across specialty infusions and pharmaceuticals.

This role focuses on verifying benefits, coordinating prior authorizations, and ensuring accurate patient data entry to streamline claims processing. The candidate will collaborate with care teams, resolve authorization questions, and provide exceptional internal and external service.

Competenze

• 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.

Mansioni

• Verify insurance for limits and parameters of policy.
• Determine if prior authorization of pre-cert is necessary and work accordingly.
• Input required patient data into system.
• Create verification notes 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).
• Collaborate with Jr. & Sr. team members to ensure appropriateness of prior authorization documentation.
• Elevate difficult verification issues when unable to resolve timely.
• Support group and management efforts with a positive attitude.
• Possess “critical” and “out of the box” thinking.
• Provide interdepartmental support as needed.
• The ideal candidate will also possess the following qualities:
• Ability to troubleshoot prior authorization issues.
• Excellent internal and external customer service and communication skills.
• Understanding of referral processes to various assistance programs as needed based on insurance coverage.

Conoscenze

Insurance verification

Communication skills

Team collaboration

Multitasking

Descrizione del lavoro

Axium Healthcare Pharmacy, Inc. is seeking an Insurance Verification Specialist to support patient management and workflow across specialty infusions and pharmaceuticals.

This role focuses on verifying benefits, coordinating prior authorizations, and ensuring accurate patient data entry to streamline claims processing. The candidate will collaborate with care teams, resolve authorization questions, and provide exceptional internal and external service.