What are the responsibilities and job description for the Specialty - Verification & Authorization Specialist position at California Specialty Pharmacy,LLC?
Job Summary:
The Verification Specialist - Specialty role is responsible for processing benefit verification and authorization responsibilities of specialty patient
accounts.
Roles and Responsibilities:
- Verifies benefit coverage and as appropriate, financial responsibility.
- Creates Insurance Benefit Summary (IBS) documents, as needed
- Identifies out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verification
- Obtains prior authorization for specialty therapies
- Review, process, and follow to completion the requirement of obtaining prior authorization for services. This excludes PBM authorizations.
- Coordinates with the Intake Specialists and the Clinical Review Team to identify and process requests for services requiring Prior Authorization and/or Pre-Determination for services rendered.
- Documents all patient interaction in EMR as a billing note
- Serves as a resource and problem resolution expert for patients, Intake and Sales
- As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Documents information in EMR and communicates as appropriate to team members
- Assists with Ready To Bill (RTB) as appropriate
- Performs other duties and special projects, as assigned
Qualifications and Experience:
Required:
- 2 or more years of experience in healthcare. reimbursement with focus on insurance verification and authorizations
- Experience with coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors; preferred but not required
- Prior work in specialty or home infusion, homecare or related field; preferred but not required.
- Strong computer skills (Microsoft Word, Excel, PowerPoint)
- Exceptional communication - verbal and written
- Exceptional interpersonal skills
- Exceptional organizational and process skills
- Ability to work well under pressure, meet timelines, and completes assigned projects
- Exceptional critical thinking and problem solving skills
- Proven performance, history in related field
- Exceptional attention to detail and demonstrated results
- Exceptional track record of customer satisfaction