Insurance Verification Specialist I

Description

eBlu Solutions was founded in 2012 to help specialty medical practices manage the complex workflow associated with high-cost infusion and injection treatments. Simply put, our solution gets patients to treatment faster.

JOB SUMMARY

The Insurance Verification Specialist is responsible for verifying patient insurance coverage to ensure necessary procedures are covered by an individual healthcare provider. They are responsible for entering patient benefit information into the system and verifying the existing information is accurate. The Insurance Verification Specialist requires an extensive amount of time on the phone with insurance payers. This position will report to the Call Team Supervisor.

Note: This position will initially be in-office 5 days a week during normal business hours. After training and initial ramp-up period, eligibility for a hybrid work schedule with 4 required in-office days per week may be granted.

Requirements

KEY RESPONSIBILITIES

• Makes outbound calls to Insurance Payers and/or Specialty Pharmacies to obtain patient benefits.
• Understands and completes Prior Authorization calls within the In Process queue
• Completes call sheets completely and accurately
• Understands and adheres to the eBlu Guarantee of a turnaround time of 8 hours for Sponsored Drugs
• Process documents based on department guidelines per standards and performance indicators.
• Maintain the highest level of patient confidentiality.
• Recognizes group discrepancies
• Utilizes all resources and tools i.e., Payer Notes, Google, Caller Guide, etc
• Provide the highest level of customer service when representing eBlu
• Actively listens to calls in Ring Central to identify training opportunities or to gather important information from the call
• Accurately interprets notes on the call sheet provided by the senior or Supervisor prior to outreach
• Provides prompt communication to Supervisor for updated Payer information
• Understanding of the Availity chat to Save and upload to Microsoft Teams Channels as needed
• Ability to investigate call sheets in Review Completed status
• Active participation in 1:1s with Supervisor
• Provides 24 hours' notice for any personal time off
• Review updates and changes communicated in Microsoft Teams chats and respond/react to the message
• Can manage day-to-day responsibilities independently with the support of the Supervisor as needed
• Other duties and responsibilities as assigned by the supervisor based on the specific client contract.

EXPERIENCE, SKILLS & QUALIFICATIONS

EDUCATION

• High School Diploma or GED required

EXPERIENCE

• 1-3 years’ experience in a health plan, facility, healthcare provider office, or pharmaceutical industry preferred
• Working knowledge of reimbursement (i.e. benefit investigation, prior authorization, pre-certification, letters of medical necessity) preferred
• Knowledge of Medical Terminology preferred
• Working knowledge of drug reimbursement issues preferred
• Understanding of Health Plan Medical Policies and Prior Authorization Criteria preferred
• Knowledge of HCPCS, CPT, and ICD-10 coding preferred
• Proficient computer skills (position requires strong data entry experience, and must be comfortable with cloud-based web applications)
• Must have excellent multitasking skills to allow for success in the role
• Exhibits critical thinking and investigative behaviors
• Understanding of Buy and Bill
• Must be very detail-oriented and organized to maintain accurate patient insurance records
• Strong communication and interpersonal skills.
• Ability to work independently as well as collaboratively in a team environment.
• Proactive and able to take initiative in driving projects forward.
• Ability to resolve problems independently
• Ability to follow instructions

PHYSICAL & TECHNICAL ENVIRONMENT

• Ability to work at a desk in the office for long periods of time.
• The noise level in the work environment is moderate.
• Specific vision abilities required by this job include close vision and color vision.
• Ability to maintain focus under high levels of pressure/multiple priorities.

BENEFITS

• Competitive pay and performance-based incentives
• Comprehensive health, dental, and vision insurance
• Retirement savings plan with company matching.
• Flexible schedules with both remote and hybrid work options.
• Professional development and growth opportunities
• Generous paid time off and holiday schedule.