niramedical
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.
- 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