Description
POSITION SUMMARY:
Benefit Verification Specialist functions associated with completing a medical and/or pharmacy benefit investigation. Initially, the Benefit Verification Specialist will utilize data from the MedeBV transaction to complete a medical benefit investigation. This process involves calling on specific payers to obtain the necessary missing data to finalize the benefit investigation. Once the data is obtained from the payer, the Benefit Verification Specialist will enter the data into CareMetx Data Wearhouse using pre-established protocols. The Benefit Verification Specialist may also complete other documentation as required for daily reporting and performance measurement activities.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Collects and reviews all patient insurance benefit information from the payer to the degree authorized by the SOP of the program.
- Provides exceptional customer service to all internal team members; resolves any requests in a timely and accurate manner; escalates issues accordingly.
- Maintains frequent phone contact with assigned payers.
- Reports any reimbursement trends/delays to supervisor.
- Coordinates with inter-departmental associates, as necessary.
- Communicates effectively to payers to ensure accurate and timely benefit investigations.
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
- Ability to work remotely; typically receives little instruction on day-to-day work,
- Performs related duties as assigned.
Requirements
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Ability to communicate effectively both orally and in writing.
- Ability to build productive internal/external working relationships.
- Strong interpersonal skills.
- Strong negotiating skills.
- Strong organizational skills; attention to detail.
- General knowledge of medical/pharmacy insurance.
- Global understanding of commercial and government payers preferred.
- Ability to proficiently use Microsoft Excel, Outlook and Word.
- Ability to problem solve.
- Strong time management skills and excellent independent work ethic.
- Customer satisfaction focused.