🕒 14 days ago
Prepare and process medical bills, submit and track insurance claims, resolve billing inquiries, process payments, and maintain accurate, confidential patient billing records in compliance with medical coding requirements.
Benefits and Authorizations Specialist Lead
📅 Feb 21, 2025
Insurance Eligibility VerificationInsurance Benefits And CoveragePrior AuthorizationsPre-certifications
📜 Description
- Support denial mitigation through peer-to-peer reviews and appeals.
- Apply payer requirements and regulatory guidelines for infusion drug authorizations.
- Calculate and communicate patient financial responsibility.
- Identify patient assistance programs and support manufacturer copay assistance enrollment.
🛠️ Requirements
- High school diploma or equivalent.
- 2-3 years of experience in medical insurance verification and prior authorizations; infusion services experience preferred.
- 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.
- Athena experience is a plus, but not required.
- Strong organization, attention to detail, multitasking, critical thinking, and decisive judgment.
✨ Benefits
- Verify and document insurance eligibility
- Benefits
- Obtain insurance authorizations and pre-certifications.
Full job description
Job Summary: 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.
Key Responsibilities:
Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
Obtains insurance authorization and pre-certification for office visits and infusion services.
Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
Calculate and communicate patient financial responsibility.
Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications:
High school diploma or equivalent
2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
· Knowledge of insurance terminology, plan types, structures, and approval types
· Previous experience with J-codes, CPT and ICD-10 coding
Previous Athena use a plus, but not a requirement
· Knowledge of medical terminology and clinical documentation review
Strong organizational skills
Detail-oriented
Ability to multi-task and work well in a fast-paced setting
Critical thinking skills and decisive judgment
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