Job Summary: The Benefits Specialist 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:
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Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
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Obtains insurance authorization and pre-certification for office visits and infusion services.
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Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
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Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
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Calculate and communicate patient financial responsibility.
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Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications:
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High school diploma or equivalent
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2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
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· Knowledge of insurance terminology, plan types, structures, and approval types
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· Previous experience with J-codes, CPT and ICD-10 coding
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Previous Athena use a plus, but not a requirement
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· Knowledge of medical terminology and clinical documentation review
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Strong organizational skills
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Detail-oriented
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Ability to multi-task and work well in a fast-paced setting