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Benefits and Authorizations Specialist Lead
Niramedical
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About this role
Job Summary: The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.
Key Responsibilities:
- Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
- Obtains insurance authorization and pre-certification for office visits and infusion services.
- Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
- Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
- Calculate and communicate patient financial responsibility.
- Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications:
- High school diploma or equivalent
- 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
- · Knowledge of insurance terminology, plan types, structures, and approval types
- · Previous experience with J-codes, CPT and ICD-10 coding
- Previous Athena use a plus, but not a requirement
- · Knowledge of medical terminology and clinical documentation review
- Strong organizational skills
- Detail-oriented
- Ability to multi-task and work well in a fast-paced setting
- Critical thinking skills and decisive judgment
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