Insurance Specialist

6 hours ago


Pompano Beach, Florida, United States Patient Care America Full time
Job Summary

We are seeking a highly skilled Insurance Specialist to join our team at Patient Care America. The successful candidate will be responsible for verifying and validating patient insurance benefits, ensuring accurate and timely submissions to insurance companies.

Key Responsibilities:

  • Verify and validate patient insurance benefits through phone, online portals, and other communication channels.
  • Obtain and document detailed information on coverage, copayments, deductibles, and other relevant insurance details.
  • Monitor new referrals throughout the insurance verification process to ensure timely completion.
  • Collaborate with healthcare providers to gather necessary information for authorization submissions.
  • Prepare and submit authorization requests to insurance companies, ensuring accuracy and completeness.
  • Follow up with insurance companies on authorization status and communicate with internal teams.
  • Handle incoming and outgoing calls related to insurance benefits.
  • Effectively communicate with patients, healthcare providers, and insurance companies to address inquiries and provide clarification on benefit verification and authorization processes.
  • Collaborate with the Lead Insurance Specialist to escalate and resolve complex issues.
  • Prepare and submit appeal requests to insurance companies, ensuring accuracy and completeness.

Requirements:

  • High School Diploma or equivalent required; two years of college education preferred.
  • 0-3 years of insurance verification and/or pharmacy tech experience, or equivalent experience as an Insurance Verifier or similar position.
  • 0-2 years of experience in obtaining prior authorizations.
  • 0-2 years of experience with the coordination of benefits, secondary insurance, and/or patient assistance programs.
  • Knowledge of medical benefit plan design and ability to explain concepts to patients and healthcare providers.
  • At least 2 years of experience in providing customer service to internal and external customers.
  • Problem-solving experience.
  • Willingness to work extra hours based on department needs.
  • Computer proficiency in standard office applications and ability to learn industry-specific software applications.


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