Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
Identify any coverage restrictions and details on how to expedite patient access
Document and initiate prior authorization process and claims appeals
Report any reimbursement trends or delays in coverage to management
Act as a liaison for field representatives, health care providers and patients

In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage
2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements
Excellent verbal communication skills and grammar
Salesforce system experience preferred

Insurance Verification Specialist – Specialty Pharmacy

Key skills