Insurance Verification Analyst
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Job Description
Insurance Verification Analyst investigating patient insurance benefits, claims, and prior authorizations. Supporting healthcare providers and patients through referral management and medication access.
Responsibilities:
- Provide subject matter expertise on medical and prescription insurance coverage, verification, claim billing, medication prior authorization, appeal filing, and alternate financial assistance opportunities
- Accurately document information in appropriate systems and formats
- Communicate referral status to physicians and patients via phone, fax, and/or the core pharmacy system
- Assist offices through prior authorization and appeal documentation and filing
- Monitor authorization and appeal status to support rapid turnaround and patient access to medication
- Use internal and web tools to investigate pharmacy and medical benefits
- Collaborate with health insurance payors and providers and maintain payor intelligence resources
- Enter patient demographic and health insurance information into the hub information system
- Notify physicians of incomplete or incorrect insurance information
Requirements:
- 1-3 years of work experience in a healthcare or reimbursement setting
- Previous experience in a call center environment, healthcare office, corporate setting, healthcare insurance provider, or pharmacy is required
- Thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs
- Knowledge of billing, alternate funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations
- Pharmacy call center experience preferred for A+ candidates
- Healthcare call center and medical claims experience preferred for A- candidates
Benefits:
- Medical, dental & vision
- Critical Illness, Accident, and Hospital coverage
- 401(k) Retirement Plan with pre-tax and Roth post-tax contributions
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
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