Benefits and Authorizations Specialist Lead
Job Summary: The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.
Key Responsibilities:
ā¢ Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
ā¢ Obtains insurance authorization and pre-certification for office visits and infusion services.
ā¢ Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
ā¢ Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
ā¢ Calculate and communicate patient financial responsibility.
ā¢ Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications:
ā¢ High school diploma or equivalent
ā¢ 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
ā¢ Ā· Knowledge of insurance terminology, plan types, structures, and approval types
ā¢ Ā· Previous experience with J-codes, CPT and ICD-10 coding
ā¢ Previous Athena use a plus, but not a requirement
ā¢ Ā· Knowledge of medical terminology and clinical documentation review
ā¢ Strong organizational skills
ā¢ Detail-oriented
ā¢ Ability to multi-task and work well in a fast-paced setting
ā¢ Critical thinking skills and decisive judgment
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Key Responsibilities:
ā¢ Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
ā¢ Obtains insurance authorization and pre-certification for office visits and infusion services.
ā¢ Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
ā¢ Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
ā¢ Calculate and communicate patient financial responsibility.
ā¢ Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications:
ā¢ High school diploma or equivalent
ā¢ 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
ā¢ Ā· Knowledge of insurance terminology, plan types, structures, and approval types
ā¢ Ā· Previous experience with J-codes, CPT and ICD-10 coding
ā¢ Previous Athena use a plus, but not a requirement
ā¢ Ā· Knowledge of medical terminology and clinical documentation review
ā¢ Strong organizational skills
ā¢ Detail-oriented
ā¢ Ability to multi-task and work well in a fast-paced setting
ā¢ Critical thinking skills and decisive judgment
Apply tot his job
Apply To this Job