Verification Specialist - Specialty

ContinuumRx; Birmingham (AL); On-site; USD 42,000 - 62,000; Full time

Job summary

ContinuumRx is seeking a Verification Specialist - Specialty to verify insurance benefits and obtain authorization for specialty therapies. You will document interactions in the EMR and communicate with patients, intake, and sales to resolve issues promptly.

The role requires the ability to determine patient financial responsibility, coordinate benefits, and manage multiple tasks under time pressure with strong attention to detail.

Qualifications

• 2+ years of experience in healthcare reimbursement with a focus on insurance verification and authorizations.
• Experience in coordination of benefits (HMO, PPO, TPA, state and federal payors) is preferred.
• Prior work in specialty or home infusion or related field is preferred.
• Knowledge of specialty medications (IVIG, injections) and PA requirements.
• Exceptional communication and interpersonal skills; ability to work under pressure.

Responsibilities

• Verifies benefit coverage and financial responsibility.
• Creates Insurance Benefit Summary (IBS) documents as needed.
• Identifies out-of-pocket costs prior to services.
• Obtains prior authorization for specialty therapies.
• Documents all patient interactions in the EMR as billing notes.
• Acts as a resource for patients, Intake and Sales to resolve issues.
• Verifies insurance coverage through payor websites or by calling payors.

Skills

Insurance verification

Authorization processes

Communication

Attention to detail

Customer service

Time management

Education

High School Diploma or GED

Tools

EMR systems

Job description

The Verification Specialist - Specialty role is responsible for processing benefit verification and authorization responsibilities of specialty patient accounts.

Roles and Responsibilities

• Verifies benefit coverage and as appropriate, financial responsibility
• Creates Insurance Benefit Summary (IBS) documents, as needed
• Identifies out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance
• eligibility/coverage information provided by payor at time of insurance verification
• Obtains prior authorization for specialty therapies
• Documents all patient interaction in EMR as a billing note
• Serves as a resource and problem resolution expert for patients, Intake and Sales
• As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Documents
• information in EMR and communicates as appropriate to team members
• Assists with Ready To Bill (RTB) as appropriate
• Performs other duties and special projects, as assigned

Qualifications and Experience

• Minimum of High School Diploma or GED.
• 2 or more years of experience in healthcare reimbursement with a focus on insurance verification and authorizations.
• Experience in coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors; preferred but not required.
• Prior work in specialty or home infusion, homecare or related field; preferred but not required
• Knowledge of Specialty medications; i.e. IVIG, injections
• Knowledge of Ambulatory Infusion Center verification and PA requirements
• Exceptional communication - verbal and written
• Exceptional interpersonal skills
• Exceptional organizational and process skills
• Ability to work well under pressure, meet timelines, and completes assigned projects.
• Exceptional critical thinking and problem solving skills
• Proven performance, history in related field
• Exceptional attention to detail and demonstrated results
• Exceptional track record of customer satisfaction