Benefits and Authorizations Specialist Lead - Remote

Overview

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.

In Short

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
• Obtain insurance authorization and pre-certification for office visits and infusion services.
• Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
• Maintain knowledge of infusion drug authorization requirements for all payers.
• Calculate and communicate patient financial responsibility.
• Provide financial assistance support to patients including identifying assistance programs.

Requirements

• High school diploma or equivalent.
• 2-3 years of experience in medical insurance verification and prior authorizations.
• Knowledge of insurance terminology, plan types, structures, and approval types.
• Experience with J-codes, CPT and ICD-10 coding.
• Knowledge of medical terminology and clinical documentation review.
• Strong organizational skills and detail-oriented.
• Ability to multi-task and work well in a fast-paced setting.
• Critical thinking skills and decisive judgment.

Benefits

• Comprehensive health benefits.
• Opportunities for professional development.
• Flexible work environment.