Verification of Benefits Specialist

The Fountain Group is currently sourcing for a Verification of Benefits Specialist for a prominent client of ours. This position is out of Plano, TX. Pay: $19-$20/hour Duration: 6 month contract — potential to extend or convert based on performance and budget. Shift: 100% Onsite, 8am - 5pm M-F What you’ll do Assist with multiple levels of appeal in the event of initial coverage denial. Forward authorized confirmation for procedure to designated patient provider. In addition, this position will provide in‑servicing to new patient providers surrounding the pre‑authorization process. Responsible for managing multiple cases simultaneously within specific time frames. Follow all policies and procedures related to performing the job role, adhering to all data use, storage and privacy policies as outlined by Client. Verify benefits, complete authorization requests promptly. Timely follow up for requested authorizations. For each procedure, audit required clinical documents for completeness and accuracy. Obtain authorization for the facility, equipment and physician to perform various procedures from the insurance carrier. Work with key provider contacts to obtain required clinical information for authorizations. Work with respective carrier’s utilization review department to obtain appropriate authorizations. Work within established guidelines when necessary to process appeal for denied requests. Train patients and their designated providers on pre‑authorization processes and requirements, in person or by phone. Work individually and in a team environment to educate assigned Field Territory Managers and Clinical Specialists. Education and experience you’ll bring Associate degree in Nursing/Home Health (LVN/LPN) or related field required. Minimum of 2 plus years experience in a utilization (medical approval) environment or similar work experience. Knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. Experience in medical device or DME billing is a plus. Proficient with Microsoft Office (Word & Excel specifically). Medical billing software experience is a plus. Knowledge of current CPT codes and familiarity with ICD‑10CM (diagnosis coding). Ability to accurately meet required time frames/deadlines. Ability to work as a team player and share workloads with other team members. Excellent verbal and written communication skills. Ability to train/present concepts to others. #J-18808-Ljbffr The Fountain Group