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in Mount Vernon, IL
Insurance Verification Specialist - Full-time
•30 days ago
Hours | Full-time |
---|---|
Location | MOUNT VERNON, IL MOUNT VERNON, Illinois |
About this job
Responsible for benefit verification of all insurance coverage for our Third-Party lines of business. Responsibilities include verifying insurance, allowable, pre-certification/pre-authorization, obtaining dispensing orders and confirming the necessary documentation is on file. Work activities include phoning physicians’ offices for dispensing orders and follow up, releasing order for shipment, review payer specific requirements.
Qualification
Education
- Verify eligibility and determine patient benefit coverage and product allowable.
- Obtain and confirm the necessary dispensing order/ documentation on file.
- Complete pre-certification/authorization. Obtain additional information such as medical necessity, letter of medical necessity or charts notes to submit for prior authorization.
- Confirm Authorization/Orders are qualified prior to shipping. Release order for shipping once verification and necessary shipping requirements have been met.
- Work with vendor billing and reimbursement services to resolve any verification issues as appropriate.
- Keep updated on all benefit changes for third party insurance carriers within their area of responsibility.
- Establish and maintain relationships with physician offices and other referral sources.
- Maintain confidentiality of all information.
Qualification
Education
- High School diploma or equivalent.
- Experience working with verification, documentation and medical records.
- Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines.
- Experience with MS Office Suite and SAP.
- Experience applying knowledge of medical terminology and verification.
- Certified Coder or experience with medical coding specific to ICD-9/ ICD-10.
- Experience applying knowledge of HIPAA Privacy and Security Rules and CMS security requirements
- Experience applying knowledge of Medicare, Medicaid and Commercial payers, its rules and reimbursement