Benefits and Authorizations Specialist

Job Summary: The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support  to ensure patients receive coverage for medical and infusion services provided.

Key Responsibilities:

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.

• Obtains insurance authorization and pre-certification for office visits and infusion services.

• Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.

• Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.

• Calculate and communicate patient financial responsibility.

• Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

Qualifications:

• High school diploma or equivalent

• 2-3 years of experience in medical insurance verification and prior authorizations.  Experience in infusion services is preferred.

• ·       Knowledge of insurance terminology, plan types, structures, and approval types

• ·       Previous experience with J-codes, CPT and ICD-10 coding

• Previous Athena use a plus, but not a requirement

• ·       Knowledge of medical terminology and clinical documentation review

• Strong organizational skills

• Detail-oriented

• Ability to multi-task and work well in a fast-paced setting

• Critical thinking skills and decisive judgment