Specialty - Verification & Authorization Specialist

Verification Specialist - Specialty

The Verification Specialist - Specialty role is responsible for processing benefit verification and authorization responsibilities of specialty patient accounts.

Roles and Responsibilities:

• Verifies benefit coverage and as appropriate, financial responsibility.
• Creates Insurance Benefit Summary (IBS) documents, as needed
• Identifies out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verification
• Obtains prior authorization for specialty therapies
• Review, process, and follow to completion the requirement of obtaining prior authorization for services. This excludes PBM authorizations.
• Coordinates with the Intake Specialists and the Clinical Review Team to identify and process requests for services requiring Prior Authorization and/or Pre-Determination for services rendered.
• Documents all patient interaction in EMR as a billing note
• Serves as a resource and problem resolution expert for patients, Intake and Sales
• As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Documents information in EMR and communicates as appropriate to team members
• Assists with Ready To Bill (RTB) as appropriate
• Performs other duties and special projects, as assigned

Qualifications and Experience:

Required:

• 2 or more years of experience in healthcare. reimbursement with focus on insurance verification and authorizations
• Experience with coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors; preferred but not required
• Prior work in specialty or home infusion, homecare or related field; preferred but not required.
• Strong computer skills (Microsoft Word, Excel, PowerPoint)
• Exceptional communication - verbal and written
• Exceptional interpersonal skills
• Exceptional organizational and process skills
• Ability to work well under pressure, meet timelines, and completes assigned projects
• Exceptional critical thinking and problem solving skills
• Proven performance, history in related field
• Exceptional attention to detail and demonstrated results
• Exceptional track record of customer satisfaction

California Specialty Pharmacy,LLC