Insurance Verification Representative Elikn, NC Monday - Friday 8a-5p EST In - Office

Position Description:

Support verification process by assisting with team collaboration and contributing to efficient insurance verification workflows. Work to secure in- and out-of-network referrals through ongoing communication with health plans, providers, and patients. Help ensure comprehensive support by exploring coverage options, obtaining required documentation, and maintaining accurate records, with a primary focus on Continuous Glucose Monitors (CGMs).

Essential Responsibilities and Duties:

1. Continuously expands expertise in Medicare, Medicaid, and commercial payers, with a focus on Continuous Glucose Monitors (CGM) supplies, to maximize opportunities for servicing both in- and out-of-network patient referrals, including securing gap exceptions or standard prior authorizations and PCP referrals, LOA, TPAs, and cash pay solutions.

2. Support the tracking and maintenance of team KPIs, assisting with reporting and ongoing review of benchmarks related to sales, verification workflows, and health plan benefit administration. Help identify performance trends and contribute to problem-solving efforts, with a primary focus on CGM and Maternity lines of business.

3. Assist in managing workflow processes and project timelines by coordinating tasks, supporting resource needs, and helping ensure deliverables are completed on time. Collaborate with cross-functional teams to support organizational goals and objectives.

4. Actively contributes to the development and maintenance of private insurance contact cards, ensuring high utilization across Billing, Client Operations, Quality Assurance, and Payer Relations teams.

5. Participates in the Certified Training Assistant (CTA) program as a CTA, and successfully completes available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development.

6. Support departmental goals by assisting with referral, verification, and authorization and follow-up processes. Monitor and process orders accurately, coordinate with referral and insurance partners as needed, and help maintain positive relationships across the organization.

7. Ensure accurate and timely attention to workflow processes within the CGM division, including tracking and completing all tasks across different workflows. Assist with administrative responsibilities and maintaining required patient documentation. Support supervisors as needed to help ensure smooth daily operations and complete patient files.

8. Participates in in-services, education, and training to address and resolve knowledge gaps and issues regarding health plan protocols, procedures, processes, and overall effectiveness of referral sources.

10. Maintains an excellent attendance record and drives strong attendance among department team members through accountability measures and incentives.

11. Adheres to all company policies and procedures regarding employment, safety, and compliance, and reports any concerns of non-compliance to management immediately.

12. Performs other related duties as requested and assigned by Leadership.