Insurance Verification Coordinator III

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

Manage the daily functions of the Insurance Verification area including verification of insurance coverage, re-verifying coverage for existing patients, enter and update patient demographics into the computer system, and securing reimbursement related paperwork. Generate price/coverage quotes. Acts as the point of contact for Account Manager insurance verification, referrals and authorizations.

Responsibilities

• Work effectively and maintain expected productivity.

• Enter and update patient demographics into the computer system.

• Verify insurance coverage, calculate costs and document details in the patient profile.

• Medical vs pharmacy benefit determination.

• Coordinates and communicates with Account Manager to expedite insurance checks, authorizations and referrals.

• Generate a financial responsibility letter.

• Review benefits with patient via phone.

• Identify copay/foundation assistance and/or donated drug.

• Track, monitor and secure necessary insurance documents.

• Obtain prior authorizations as required.

• Coordinate completion of Financial Assistance forms, payment agreements and waivers.

• Assist with training new employees.

• Organize and prioritize tasks to be completed.

• Create new hospital and physician codes as needed.

• Give high priority to client satisfaction and customer needs.

• Cooperate with other staff members when planning and organizing reimbursement activities.

• Demonstrates the ability to work effectively and maintain expected productivity.

• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all

• assigned tasks.

• Assist with researching reimbursement issues.

• Performs in accordance with system-wide competencies/behaviors.

• Performs other duties as assigned.

Skills & Abilities

• Excellent written and verbal communication

• Organization

• Time Management

• Professional

Requirements

• HS diploma or GED required.

• 3+ years of insurance verification, prior authorization or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.

• Knowledge of medical terminology required.

• Knowledge of payer websites, eligibility, coordination of benefits required.

• Knowledge of pharmacy vs medical payers and authorization required.

• Knowledge of plan formularies and authorization requirements required.

• Proficient computer skills and Microsoft Office Products required.

• Excellent math skills.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.