Lead Insurance Benefits Verification Specialist

The Lead Insurance Benefits Verification Specialist is responsible for supporting the insurance and benefits verification functions of the assigned client(s) in accordance with the policies and practices of Prochant. The position will be responsible for gathering patient specific insurance information for the prescribed therapy, and use that information to obtain benefits and authorization to provide services. The position will be responsible for facilitation of medical benefits and prior authorizations for assigned client(s)

Requirements

Education: High School Diploma or GED

Experience: Three years previous experience determining eligibility for all commercial, PBM, Medicaid and/or Medicare payers required. Knowledge of insurance payor rules and regulations. Experience with HIPPA regulated environment, processing ICD10, EOB’s, third party payers, Medicare, managed care, and private pay. Must have a firm understanding of Infusion Pharmacy benefit, obtaining authorizations and billing experience.

Specialized knowledge, skills, or abilities: Excellent working knowledge of commercial, Medicaid and Medicare, including PBM’s and managed plans for infusion therapies. Must have the ability to make independent decisions and exercise discretion when working with customers, providers, and insurance companies. Demonstrate a willingness to cooperate, work and communicate with coworkers, supervisors, and outside client contacts. Excellent verbal and written communication skills required. Strong organization skills. Must be detail oriented, follow through on tasks, problem solve, trouble shoot, and be able multi-task in a fast paced environment. Maintain a professional attitude with all staff and prospective clients. Ability to communicate effectively with all departments. Must have ability to operate independently while maintaining collaboration with the client intake team. Must be able to talk on the phone for extended periods of time.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Verify insurance eligibility and benefits for patients.
• Obtain and facilitate prior authorizations
• Validate insurance information of patients for accuracy and completeness and resolve discrepancies as needed.
• Verify all active client's Medicaid the first week of each month.
• Assist in correcting billing denials as it pertains to benefits and authorizations
• Obtain reimbursement information from Commercial, Medicare and Medicaid plans.
• Monitor the status of new referrals and non-routine patient cases.
• Follow up with client on the status of pending referrals, or patients with a change in orders
• Perform data entry utilizing Electronic Health Record for documentation of insurance information with minimal errors.
• Analyze patient data loaded into the billing system, from admission through discharge, to ensure that all key elements that affect billing and collections are present and accurate.
• Provide patient notifications to patients or patients representatives including End of Coverage Notifications, Recertification Application, and any other payor required documents prior to the start of a new patient.
• Identify and recommend improvement opportunities based upon root cause analysis of denied claims to management.
• Full understanding of the use of PBM benefits when applicable to patient benefits/therapy
• Stay up to date on Medicare, Medicaid plans, (including managed plans) benefits and prior Authorization requirements

Benefits

Prochant offers some of the best benefits in the industry! We take great care of our employees. Prochant’s Fortune-500 level benefits package includes:

• Health Insurance
• Gap Insurance
• Dental Insurance
• Vision Insurance
• Short Term / Long Term Disability (company paid)
• Term Life Insurance (company paid, employee can elect additional)
• Full suite of supplemental insurance plans, including:
  • Disability Income
  • Level Term Life
  • Accident Insurance
  • Critical Illness Insurance
• Floating holidays and paid time off
• 401K with company match