Danville, California | Contract
- Investigates patient' s insurance benefits. Identifies network providers, provider restrictions, co-pays as needed.
- Documents requirements for prior authorization and medical review process.
- Documents activities appropriately in progress notes.
- Pursue product coverage for patients in accordance with the payor' s authorization requirements within the department' s established performance criteria.
- Create written communication to customers regarding reimbursement status.
- Maintains payor profiles by recording payor specific data promptly into the system. Consults with team members on an as needed basis.
- Collects and enters data for distributor referral cases.
- 4 years experience in Healthcare reimbursement required; verifying benefits, prior authorizations and working with public and private insurance.
- Must be able to drive for results.
- Proficient in all aspects of reimbursement (i.e. benefit investigation, pay reimbursement policies).
- Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
- Ability to work collaboratively in a team structure and responsibly delegates next steps to appropriate team members.
- Demonstrates effective problem solving and excellent customer service.
- Exceptional attention to detail and ability to prioritize tasks.
- Requires computers skills including MS Excel.
1) Medical Insurance payer knowledge - demonstrated in phrases: Benefit investigations/ verifications, prior authorizations, Insurance networks, Specialty Pharmacies, Pharmacy Benefit managers, Major Medical.
2) 2+ years experience verifying medical benefits.
3) Evidence of experience verifying benefits with Private payers.
4) Evidence of experience working with Public payers (Medicare & Medicaid).
5) Proficient computer skills.
6) Work in team environment.
NICE TO HAVES:
1) Experience with Medicare Part B & Medicare Part D.
2) Work at a reimbursement service company.
3) Evidence of thorough knowledge of the public & private payer landscapes.
4) Work at or with a specialty pharmacy.
- BS/BA preferred or relevant experience.