Verification Specialist - Specialty

Job Description

Job Description

About the Role:

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
• 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

• Minimum of High School Diploma or GED.
• 2 or more years of experience in healthcare reimbursement with a focus on insurance verification and authorizations.
• Experience in 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
• Knowledge of Specialty medications; i.e. IVIG, injections
• Knowledge of Ambulatory Infusion Center verification and PA requirements
• 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
• Weinfuse program experience