Help patients get access to the medications and therapies they need.
Work directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and coverage.
Support healthcare providers with questions regarding coding and billing, navigating complex reimbursement issues.
Provide support for Prior Authorizations (PA) for an assigned caseload and assist with the appeals process to access medications.
Ensure compliance with company requirements and defined standards.
Conduct benefit investigations by making outbound calls to payers to verify patient insurance benefits.
Document patient-specific benefits including coverage, cost share, and access/provider options.
Identify coverage restrictions and expedite patient access where possible.
Document and initiate the prior authorization process and claims appeals.
Report reimbursement trends or delays to management.
Act as a liaison for representatives, 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

Medical, dental, vision, life, & short-term disability insurance
Teledoc services for those enrolled in medical insurance
Supportive, progressive, fast-paced environment
Competitive pay structure
Matching 401(k) with immediate vesting
Legal insurance
100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary.
$1,000 tenure vacation bonus upon 3-year anniversary and $2,500 upon 5-year anniversary.
Quarterly and annual award programs recognizing employees' contributions and achievements.

Insurance Verification Specialist – Specialty Pharmacy

Key skills