Insurance Coverage Specialist
3 weeks ago
As an Insurance Verification Coordinator at CarepathRx, you will play a vital role in transforming hospital pharmacy into a revenue generator. Your primary responsibility will be to manage the daily functions of the Insurance Verification area, ensuring seamless verification of insurance coverage, re-verification for existing patients, and accurate entry of patient demographics into the computer system. You will also be responsible for securing reimbursement-related paperwork, generating price/coverage quotes, and acting as the point of contact for Account Manager insurance verification, referrals, and authorizations.
Key Responsibilities
- Verify insurance coverage, calculate costs, and document details in the patient profile.
- Enter and update patient demographics into the computer system.
- Work effectively and maintain expected productivity.
- Coordinate and communicate with Account Manager to expedite insurance checks, authorizations, and referrals.
- Generate a financial responsibility letter.
- Review benefits with patients via phone.
- Identify copay/foundation assistance and/or donated drug.
- Track, monitor, and secure necessary insurance documents.
- Obtain prior authorizations as required.
- Coordinate completion of Financial Assistance forms, payment agreements, and waivers.
- Assist with training new employees.
- Organize and prioritize tasks to be completed.
- Create new hospital and physician codes as needed.
- Give high priority to client satisfaction and customer needs.
- Cooperate with other staff members when planning and organizing reimbursement activities.
- Demonstrate the ability to work effectively and maintain expected productivity.
- Meet quality standards, show pride in performance, and demonstrate reliability and follow-through on all assigned tasks.
- Assist with researching reimbursement issues.
- Perform in accordance with system-wide competencies/behaviors.
- Perform other duties as assigned.
Requirements
- High School diploma or GED required.
- 3+ years of insurance verification, prior authorization, or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.
- Knowledge of medical terminology required.
- Knowledge of payer websites, eligibility, coordination of benefits required.
- Knowledge of pharmacy vs medical payers and authorization required.
- Knowledge of plan formularies and authorization requirements required.
- Proficient computer skills and Microsoft Office Products required.
- Excellent math skills.
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