The Right Staff

Insurance Specialist

Dec 20, 2012
Dec 24, 2012
Employment Status
Full Time
Position Title: Insurance Specialist
Department: Customer Care and Reimbursement
Status: Temp to Hire
Position Status: Exempt
Reports To: Senior Manager of Customer and Reimbursement Services
Direct Reports: None
E-PHI Access: Full Access

Position Summary:
The Insurance Specialist is responsible for processing all prescription orders. Position performs the insurance verification and authorization process. Position also processes appeal cases arising from authorization denials. Responsible for meeting established department and company goals and objectives.

Duties and Responsibilities:
• Processes all prescription orders and determines risk of shipping prior to obtaining an authorization
• Handles incoming Customer calls
• Performs in-depth insurance verification with all payor sources
• Responsible for processing all authorizations, initial and reauthorizations
• Coordinates with other team members all information needed from Healthcare Teams and Customers/Guardians, based on medical criteria and information needed by payor source, to expedite the authorization process
• Functions as primary expert to explain patient insurance benefits
• Interacts with Business Development team and internal teams to create a remarkable experience for Customers and potential Customers and to maximize business opportunities
• Responsible for coordinating peer-to-peer reviews and processing appeals resulting from authorization denials
• Interacts heavily with Provider Relations and Network Specialist on specific payor source issues and to implement operational changes to address specific payor requirements, when needed.
• Cross trains with other team members
• Attends HIPAA training and other training sessions as they arise or are required
• Performance of additional duties as assigned

Required Qualifications:
• Prefer college degree
• Minimum 3-4 years third party payor experience, preferably in a DME setting
• Demonstrated high-level customer service skills
• Excellent communication skills, both verbal and nonverbal
• Strong analytical and problem solving skills
• Ability to organize and prioritize workload
• Ability to work independently and as part of a team
• Strong knowledge of word processing, spreadsheet, and database software

Physical Requirements of the Position:

Candidate must be able to sit at computer desk in front of a PC monitor for long periods of time. Position requires incumbent to use a PC, telephone, and basic office equipment. Position requires ability to hear phone conversations, read medical and insurance information and communicate clearly with all levels of internal and external customers.

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