Insurance Verification Specialist
1 month ago
Although this position is remote, the person must reside in Florida.
Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services. Handles inbound and outbound calls with customers, physician offices, patients or third-party providers about the company’s products or services following standard SOPs and procedures, working under direct supervision. Ensures all contacts receive efficient and courteous service.
Job ResponsibilitiesRespond to all levels of inbound Pharmacy Benefit Manager (PBM) and major medical insurance related phone calls.Resolves questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) following established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution and resolve customer and PBM concerns.Requests and loads PBM and/or Major Medical insurance plans.Processes all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termed or prior authorization.Assists physicians in the prior authorization process including initiation of prior authorizations.May be cross-trained and/or work on Major Medical (MM) and Specialized PBM Plans.Verifies benefits for Major Medical via online resources or over the phone. Confirms network status, reviews FDA guidelines, and prior authorization requirements to ensure payment of claims.Resolves questions and problems submitted by customers and Major Medical plans following established guidelines and standard SOPs and procedures. Utilizes all available information to choose best solutions and resolves customer and plan covers.Facilitates the reimbursement windshields for PBM major medical claims.Identifies and assesses individual customer or patient needs and provide education on or assist with grant applications, complex funding needs, commercial copay assistance enrollment along with appropriate action to satisfy those needs.Provides primary support and expertise for specialized programs such as the patient assistance program or special handling.Manages Pharma requirements including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeal support.May administer order queue such as Submission Problems or Waiting for Payment.Documents contact interactions, records details, complaints, comments, and actions taken.About Walgreens and WBA
Walgreens (www.walgreens.com) is included in the U.S. Retail Pharmacy and U.S. Healthcare segments of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), an integrated healthcare, pharmacy and retail leader with a 170-year heritage of caring for communities. WBA’s purpose is to create more joyful lives through better health. Operating nearly 9,000 retail locations across America, Puerto Rico and the U.S. Virgin Islands, Walgreens is proud to be a neighborhood health destination serving nearly 10 million customers each day. Walgreens pharmacists play a critical role in the U.S. healthcare system by providing a wide range of pharmacy and healthcare services, including those that drive equitable access to care for the nation’s medically underserved populations. To best meet the needs of customers and patients, Walgreens offers a true omnichannel experience, with fully integrated physical and digital platforms supported by the latest technology to deliver high-quality products and services in communities nationwide.
The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law. To review benefits, please visit jobs.walgreens.com/benefits.
'An Equal Opportunity Employer, including disability/veterans'.
High school diploma/GEDExperience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction in healthcare, specialty pharmacy, PBM, call center setting or other related industryAbility to communicate clearly and effectively (written and verbal). Good interpersonal skills with the ability to communicate in a diplomatic and confidential mannerBasic level PC skills, MS Windows, MS Office Suite and/or other similar operating/software programs (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 and/or access information on-line).
-
Insurance Verification Specialist
3 weeks ago
Orlando, United States Select Source International Full timeJob DescriptionJob DescriptionJob Title: Customer Service IIILocation: - Orlando, FLDuration: - 06 Month contract with possible extension based on performanceShift Timing: - 1st shift (8 am – 4:30 pm) Summary of Duties and Responsibilities:Knowledge of VA, Workers Comp, and PA Appeals is a must Skills: understanding of Medicare rules and regulations;...
-
Insurance Verification Specialist
3 weeks ago
Orlando, United States Adept Surgical Billing Solution Full timeSeeking an experienced professional who enjoys Verification of Benefits and upfront collections. The applicant should display a positive and proactive attitude, strong organizational skills, the ability to prioritize and be a good communicator, both in writing and over the phone. This position requires frequent contact with insurance companies, physician...
-
Insurance Eligibility/Verification Specialist
4 weeks ago
Orlando, Florida, United States University of Central Florida Full timeUnleash YOUR Potential With UsAs a next-generation public research institute, we are an inclusive community of thinkers, doers, creators, innovators, healers, and leaders striving to shape the future and solve the world's most challenging problems. No matter what your role is, when you join Knight Nation, you'll play an integral role in pushing us forward to...
-
Orlando, Florida, United States University of Central Florida Full timeUnleash YOUR Potential With UsAs a next-generation public research institute, we are an inclusive community of thinkers, doers, creators, innovators, healers, and leaders striving to shape the future and solve the world's most challenging problems. No matter what your role is, when you join Knight Nation, you'll play an integral role in pushing us forward to...
-
Case Manager
3 days ago
Orlando, United States COPILOT Full timeJob DescriptionJob DescriptionCase Manager / Authorizations and Insurance Verification - NEEDED ASAPExcellent Opportunity at a Growing Company!Bring your authorizations, insurance or benefits investigation, pre-certification and/or insurance skills to an innovative, team-oriented, healthcare hub services company! Join our friendly and supportive team and...
-
Insurance Specialist
3 weeks ago
Orlando, United States CDI Corporation Full timeRAYUS Radiology, formerly Center for Diagnostic Imaging and Insight Imaging, is looking for an Insurance Specialist to join our team. We are challenging the status quo by shining light on radiology and making it a critical first step in diagnosis and proper treatment. Come join us and shine brighter together! As an Insurance Specialist, you will provide...
-
Insurance and Patient Specialist
3 weeks ago
Orlando, United States PRIMARY CARE OF CENTRAL FLORIDA INC Full timeJob DescriptionJob DescriptionOur company was founded in 2005 and has served the Central Florida Geriatric population for 18 years. We care for patients in the Skilled Nursing Facility, Assisted Living Facilities and Home bound patients in the comfort of their homes. We are a growing company and we are looking for an outstanding full-time Insurance...
-
Insurance and Patient Specialist
2 months ago
Orlando, United States PRIMARY CARE OF CENTRAL FLORIDA INC Full timeJob DescriptionJob DescriptionOur company was founded in 2005 and has served the Central Florida Geriatric population for 18 years. We care for patients in the Skilled Nursing Facility, Assisted Living Facilities and Home bound patients in the comfort of their homes. We are a growing company and we are looking for an outstanding full-time Insurance...
-
Insurance and Patient Specialist
1 week ago
Orlando, United States PRIMARY CARE OF CENTRAL FLORIDA INC Full timeJob DescriptionJob DescriptionOur company was founded in 2005 and has served the Central Florida Geriatric population for 18 years. We care for patients in the Skilled Nursing Facility, Assisted Living Facilities and Home bound patients in the comfort of their homes. We are a growing company and we are looking for an outstanding full-time Insurance...
-
FPGA Design and Verification Engineer
2 weeks ago
Orlando, United States ICONMA Full timeGreat opportunity for a FPGA Design Engineer with Government Security Clearance! Our defense client located in Orlando is looking for FPGA Design and Verification Engineer to come in and pick up where previous FPGA Engineer left off. In this role you will be responsible for - Developing, designing, verifying, and documenting Field Programmable Gate Arrays...
-
FPGA Design and Verification Engineer
1 week ago
Orlando, United States ICONMA Full timeGreat opportunity for a FPGA Design Engineer with Government Security Clearance! Our defense client located in Orlando is looking for FPGA Design and Verification Engineer to come in and pick up where previous FPGA Engineer left off. In this role you will be responsible for - Developing, designing, verifying, and documenting Field Programmable Gate Arrays...
-
Underwriting Support Specialist I
6 days ago
Orlando, United States Frontline Insurance Full timeJob DescriptionJob DescriptionSalary: Join our dynamic team of innovators, creators, and problem solvers! At Frontline Insurance, we're on a mission to Make Things Better! We believe in fostering a collaborative, inclusive, and growth-oriented work environment where every team member can thrive and make a meaningful impact.At Frontline Insurance...
-
Personal Risk Specialist
2 days ago
Orlando, United States USI Insurance Services Full timeGeneral Description: The Personal Risk Specialist is an outside sales position focused on serving the unique insurance needs of affluent/high net worth clients. In addition to cross selling, as a primary focus for business development, this role is also expected to establish additional sources of clients. Responsibilities: Schedule appointments and...
-
Reimbursement Specialist
3 weeks ago
Orlando, United States RareMed Solutions Full timeJob DescriptionJob DescriptionPurpose: The Reimbursement Specialist (RS) is a professional role responsible for various functions, including accurate and timely resolution to client inquiries regarding specific referral status or escalation. The RS serves as a primary point of contact for payers. The RS will manage the benefits investigation, prior...
-
Reimbursement Specialist
4 weeks ago
Orlando, United States RareMed Solutions Full timeJob DescriptionJob DescriptionPurpose: The Reimbursement Specialist (RS) is a professional role responsible for various functions, including accurate and timely resolution to client inquiries regarding specific referral status or escalation. The RS serves as a primary point of contact for payers. The RS will manage the benefits investigation, prior...
-
Reimbursement Specialist
1 week ago
Orlando, United States RareMed Solutions Full timeJob DescriptionJob DescriptionPurpose: The Reimbursement Specialist (RS) is a professional role responsible for various functions, including accurate and timely resolution to client inquiries regarding specific referral status or escalation. The RS serves as a primary point of contact for payers. The RS will manage the benefits investigation, prior...
-
Sr. Reimbursement Specialist
3 weeks ago
Orlando, United States MiMedx Group Inc. Full timePOSITION SUMMARY: Determine eligibility and benefits, answer billing questions, and obtain authorizations, and predeterminations. Process insurance verification requests and secure prior authorization approvals for eligibility and benefit coverage. Research and answer questions as it relates to medical verifications of insurance policies, coding, billing,...
-
Sr. Reimbursement Specialist
1 week ago
Orlando, United States MiMedx Group Inc. Full timePOSITION SUMMARY: Determine eligibility and benefits, answer billing questions, and obtain authorizations, and predeterminations. Process insurance verification requests and secure prior authorization approvals for eligibility and benefit coverage. Research and answer questions as it relates to medical verifications of insurance policies, coding, billing,...
-
Senior Specialist, Systems Engineering
4 days ago
Orlando, United States L3Harris Technologies Full timeJob Title: Senior Specialist, Systems EngineeringJob Code: SYP4 Job ID: 9233Job Location: Orlando, FLJob Schedule: 9/80, Every other Friday off Job Description:L3Harris is seeking a Sr Systems Engineering Specialist in our Orlando, FL location.The selected individual will support our System Requirements and Integration (R&I) engineering team. This...
-
Senior Specialist, Systems Engineering
3 days ago
Orlando, United States L3Harris Technologies Full timeJob Title: Senior Specialist, Systems EngineeringJob Code: SYP4 Job ID: 9233Job Location: Orlando, FLJob Schedule: 9/80, Every other Friday off Job Description:L3Harris is seeking a Sr Systems Engineering Specialist in our Orlando, FL location.The selected individual will support our System Requirements and Integration (R&I) engineering team. This...
