Insurance Coverage Specialist

4 days ago

United PA, United States CarepathRx Full time
Job Summary

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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