Specialty - Verification & Authorization Specialist

Verification Specialist - SpecialtyThe Verification Specialist - Specialty role is responsible for processing benefit verification and authorization responsibilities of specialty patient accounts.Roles and Responsibilities:Verifies benefit coverage and as appropriate, financial responsibility.Creates Insurance Benefit Summary (IBS) documents, as neededIdentifies out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verificationObtains prior authorization for specialty therapiesReview, process, and follow to completion the requirement of obtaining prior authorization for services. This excludes PBM authorizations.Coordinates with the Intake Specialists and the Clinical Review Team to identify and process requests for services requiring Prior Authorization and/or Pre-Determination for services rendered.Documents all patient interaction in EMR as a billing noteServes as a resource and problem resolution expert for patients, Intake and SalesAs needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Documents information in EMR and communicates as appropriate to team membersAssists with Ready To Bill (RTB) as appropriatePerforms other duties and special projects, as assignedQualifications and Experience:Required:2 or more years of experience in healthcare.

reimbursement with focus on insurance verification and authorizationsExperience with coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors; preferred but not requiredPrior work in specialty or home infusion, homecare or related field; preferred but not required.Strong computer skills (Microsoft Word, Excel, PowerPoint)Exceptional communication - verbal and writtenExceptional interpersonal skillsExceptional organizational and process skillsAbility to work well under pressure, meet timelines, and completes assigned projectsExceptional critical thinking and problem solving skillsProven performance, history in related fieldExceptional attention to detail and demonstrated resultsExceptional track record of customer satisfaction