Website eBlu Solutions

We support the process for patient access to treatments

POSITION SUMMARY:
The Senior Insurance Verification Specialist coordinates, reviews and approves the work of the Insurance Verification Specialist. This position handles the more complex issues, ensures verification accuracy through reviews and auditing, builds payer groups, processes queues, conducts benefit verification, and supports junior team members with questions.

RESPONSIBILITIES:

  • Conduct full medical and pharmacy Benefit Investigations
  • Resolve more complex issues related to patient coverage/responsibility for services
  • Verify and approve work of the Insurance Benefits Verification Specialist
  • Assist with making calls that are in the “in process” queue to ensure that we meet ALL SLA’s
  • Create and set up provider groups in the system
  • Audit previous call sheets to identify issues, correct errors, and identify training opportunities
  • Work various queues and activity screens to ensure expected turn-around-times are met
  • Submit Prior Authorization forms to the payer as needed
  • Research and communicate effectively and efficiently with provider practices through secure messaging and ensure resolution of issues
  • Researches and maintains payer medical policies and prior authorization forms
  • Process documents based on department guidelines in accordance with standards and performance indicators
  • Maintains all patient confidentiality
  • Other duties and responsibilities as assigned by the supervisor based on the specific client contract

PHYSICAL AND TECHNICAL ENVIRONMENT:

  • Ability to work at a desk in the office for long periods of time.
  • 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.

REQUIRED EXPERIENCE:

  • Three to five years’ experience in a health plan, facility, healthcare provider office or pharmaceutical industry
  • Understanding of health plan medical policies and prior authorization criteria
  • Reimbursement experience (i.e. benefit investigation, prior authorization, pre-certification, letters of medical necessity)
  • General knowledge of patient assistance programs and database elements and functionality; operational policies and processes
  • Ability to work independently without direct supervision and perform work directly related to general business operations
  • Ability to exercise discretion and independent judgment that has a potential impact on the company and/or our clients
  • Experience working with insurance companies and extensive knowledge of different types of coverages and policies
  • Excellent multitasking skills
  • Detail-oriented and organized to maintain accurate patient insurance records
  • Ability to focus and work quickly within a 24-hour turnaround for patient insurance information
  • Ability to express ideas clearly in both written and oral communications
  • Ability to manage multiple priorities concurrently
  • Ability to direct the work of other team members
  • Authorization to work in the US without sponsorship

REQUIRED EDUCATION:

Bachelor’s degree or equivalent work experience

PREFERRED EXPERIENCE, SKILLS, AND ABILITIES:

  • Knowledge of Medical Terminology
  • Strong computer skills; preferably Microsoft Word or Excel software applications
  • Ability to calculate figures and amounts such as discounts and percentages; necessary to provide correct benefit and co-pay information
  • Three to five years’ experience in a call center
  • Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills

EEO CODE – eBlu Solutions is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state or local law. eBlu Solutions is an Equal Employment Opportunity and Affirmative Action Employer. EO/Minorities/Females/Disabled/Veterans

To apply for this job please visit www.eblusolutions.com.