Position Purpose:
Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits
Education/Experience:
High school diploma with 1+ years of medical billing or insurance verification experience. Bachelor s degree in related field can substitute for experience. Experience with payors and prior authorization preferred.
Foundation Care Only: Missouri Registered Pharmacy Technician is preferred, but not required
Obtain and verify insurance eligibility for services provided and document complete information in system
Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies
Collect any clinical information such as lab values, diagnosis codes, etc.
Determine patient s financial responsibilities as stated by insurance
Configure coordination of benefits information on every referral
Ensure assignment of benefits are obtained and on file for Medicare claims
Bill insurance companies for therapies provided
Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures
Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs
Handle inbound calls from patients, physician offices, and/or insurance companies
Resolve claim rejections for eligibility, coverage, and other issues
Performs other duties as assigned
Complies with all policies and standards
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
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Position Purpose: Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits
Education/Experience: High school diploma with 1+ years of medical billing or insurance verification experience. Bachelor s degree in related field can substitute for experience. Experience with payors and prior authorization preferred. Strong customer service skills.
Responsibilities:
" Obtain and verify insurance eligibility for services provided and document complete information in system
" Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies
" Collect any clinical information such as lab values, diagnosis codes, etc.
" Determine patient s financial responsibilities as stated by insurance
" Configure coordination of benefits information on every referral
" Ensure assignment of benefits are obtained and on file for Medicare claims
" Bill insurance companies for therapies provided
" Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures
" Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs
" Handle inbound calls from patients, physician offices, and/or insurance companies
" Resolve claim rejections for eligibility, coverage, and other issues
Story Behind the Need
• What is the purpose of this team?
• Describe the surrounding team (team culture, work environment, etc.) & key projects.
• Do you have any additional upcoming hiring needs or is this request part of a larger hiring initiative?
project ascend
Typical Day in the Role
• Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
• What are the performance expectations/metrics?
• What makes this role unique?
Insurance verification for medication; prior authorization appeals; speak to patients, doctors offices, & insurance plans
Inbound internal que
25 referrals/more a day
95% quality or higher
Attendance is crucial
The IV experience we are looking for is them actually obtaining the benefits from the health plan and providing to the patient. For the PA side, we re looking for experience with the candidates submitting the PA themselves.
We would like to see the candidate s resumes accurately reflect whether they actually verified benefits/submitted PA s, showcase professionalism
Candidate Requirements
Education/Certification
Required: High school diploma
Preferred: NA
Licensure
Required: NA
Preferred:
Years of experience required: 1 + years of experience
Disqualifiers: NA
Additional qualities to look for: Proficient in Microsoft Office, experience/backgrounds that do well in this role- Managed Care, Pharmacy, Medical terminology, Physician office experience, Customer Service, Call Center
• Top 3 must-have hard skills stack-ranked by importance
1
Managed Care
2
Customer Service
3
Call Center
Candidate Review & Selection
• Shortlisting process
• Candidate review & selection
• Interview information
• Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams-camera on
Required Testing or Assessment (by Vendor):
Next Steps
• Additional background check requirements (List DFPS or other specialty checks here)
• Do you have any upcoming PTO?
• Colleagues to cc/delegate
• Are there any training requirements (time off, alternate schedule, etc.)?
Remote
Skills:
Background Investigation, Call Centers, Clinical Data Collection, Co-Payments, Customer Support/Service, Diversity, Documentation, Financial Management, Health Insurance, Health Plan, Healthcare Reimbursement, High School Diploma, Information Technology & Information Systems, Insurance, Managed Care, Medical Billing, Medical Office, Medical Terminology, Medical Treatment, Medicare, Medications, Microsoft Office, Organizational Skills, Performance Metrics, Pharmacy, Purchasing/Procurement
About the Company:
Mindlance