Benefits Verification Specialist
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Job Description
Benefits verification specialist verifying insurance coverage, cost shares, and access options. Supporting pharmaceutical and healthcare clients’ specialty-therapy patient access programs at CareMetx.
Responsibilities:
- Contact insurance companies to verify patient-specific benefits for client programs
- Ask appropriate questions regarding patient benefits
- Complete data entry and/or appropriate forms to document benefits coverage
- Review patient insurance information needed to complete benefit verification
- Triage cases with missing information to the appropriate program associate
- Precisely document patient coverage, cost share, and access/provider options for various payer plans
- Identify restrictions and details for expediting patient access
- Document and initiate prior authorization processes and claims appeals when applicable
- Complete quality review of work when finalizing products
- Report reimbursement trends and delays to management
- Perform related duties and special projects as assigned
- Apply company policies and procedures to resolve a variety of issues
Requirements:
- High school diploma or GED required
- Minimum of two (2) years of directly related and progressively responsible experience in customer service, medical billing and coding, benefits verification, healthcare, business administration, or similar vocations
- Equivalent combination of education and experience will be considered
- MUST HAVE FUSION/SALESFORCE EXPERIENCE
- Advanced customer service experience
- Proficient Windows-based experience, including data entry/typing fundamentals
- Proficient with Microsoft Outlook, Word, and Excel
- Strong interpersonal skills and professionalism
- Independent problem-solving and decision-making ability
- Robust analytical skills
- Strong attention to detail
- Effective written and verbal communication
- Familiarity with verification of insurance benefits preferred
- Flexibility and ability to adapt to changing work situations
- Must be flexible on schedule and hours
- Some travel may be required
- Ability to regularly sit and occasionally lift or move up to 10 pounds
Benefits:
- Equal employment opportunity employer
- Reasonable accommodations for individuals with disabilities
- Human review of AI-assisted recruiting and employment decisions
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