Insurance Verifier (Job Number: 010060) |
Responsible for performing the appropriate procedures to verify patient eligibility, coordinate benefits, run test claims and determine patient coverage/responsibility for services and testing and implementation of new plan business.
- Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file.
- Verifies patient insurance coverage of medications, administration supplies and related pharmacy services.
- Facilitates and completes the Prior Authorization process with insurance companies and practitioner offices.
- Completes a full Medical Verification for all medications, administration supplies and related pharmacy services.
- Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility.
- Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization any other insurance rejections.
- Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary; Places outbound calls to patients or physicians offices to obtain additional information needed to process the script or to notify of delay in processing script.
- Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.
- Performs other related duties as assigned.
Basic Qualifications & Interests (BQIs)
- HS Diploma/GED and at least 1 year insurance verification and/or pharmacy technician experience OR at least 6 months specialty pharmacy experience.
- Pharmacy Technician License as granted by the state Board of Pharmacy or the ability to immediately become licensed (will sponsor).
- At least 1 year experience in communicating both verbally (on phone, one-on-one, to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients).
- Basic level skill experience in the Microsoft Office package: Word (creating documents, entering and formatting text, page layouts, creating tables, and adding graphics), Excel (creating worksheets, entering data, creating basic formulas, working with cells and rows) and PowerPoint (creating a new presentation from a design template, adding and removing slides, entering and formatting text, adding speaker notes, and viewing presentations).
- Experience in providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
- Experience entering data into databases (ex: MS Access).
- Typing skills of a minimum 25 words per minute.
- Basic Internet Explorer skills experience to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online.
- Basic level PC skills experience (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents, access information on-line, etc.).
Preferred Qualifications & Interests (PQIs)
- At least 1 year experience in call center experience.
- At least 1 year experience in pharmacy benefit or medical billing experience.
- Pharmacy Technician Certification.
- At least 1 year previous experience in healthcare or pharmacy setting.
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