Benefits and Authorizations Specialist Lead

About this role

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
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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
• Previous Athena use a plus, but not a requirement
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• ·       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