Insurance Verifiers in Irving, TX
Details below! If interested and would like to hear more about this opportunity, please email updated resume to firstname.lastname@example.org
Contract: initial 3-6 months with possibility to convert permanent based on performance
Location: Irving, TX 75063
Shift: Must be flexible to work any 8 hour shift between 7am – 7pm Monday – Friday
*Must be flexible to work Saturdays as Saturdays will most likely become a requirement during PEAK – if they get assigned a Saturday shift, it will be every Saturday (NOT a rotation). Typical Saturday hours are 8am to 4:30pm but this is subject to change based on business need.
Shifts are assigned based on performance, tenure and attendance
OT: Typically only during peak, however, may be needed based on business need
Training: two weeks in classroom, two weeks on the job training and additional training as needed
?Experience: Call center – they will be on the phones, both inbound and outbound. Pharmacy and Medical Insurance experience is preferred.
- Responsible for verifying patient eligibility, coordinating benefits, running test claims and determining patient coverage/responsibility for services including, but not limited to primarily major medical insurance benefits verification, complex insurance plan verification and high volume PBM plans.
- The IVS need to understand and work with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical, and PBM.
- Understanding the authorization process is a must.
- The IVS will also be responsible for the coordination of benefits investigation and partnering with patient assistance programs.
- May also assist with testing and implementation of new planned business.
- Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file.
- Verifies patient insurance coverage of medications, administration supplies and related pharmacy services through proper investigation into either major medical benefits (including Medicare) or pharmacy benefits.
- Facilitates and completes the prior authorization process with insurance companies and practitioner offices.
- Completes a full Medical Verification for all medications, administration supplies and related pharmacy services.
- Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility.
- Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization and any other claim rejections.
- Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary.
- Places outbound calls to patients or physicians’ offices to obtain additional information needed to process the script or to notify of delay in processing script.
- Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage.
- At least 2 years of insurance verification and/or pharmacy tech experience in using J-codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B&D billing, Major Medical, PBM, authorization
- At least 2 years of experience in obtaining prior authorizations.
- At least 2 years of experience with the coordination of benefits, secondary insurance and/ or patient assistance programs.
- At least 2 years of experience with concepts of plan design and comfortable with the processes of overrides and rejections.
- Knowledge of and ability to explain concepts of medical benefit plan design (cost benefit, co-insurance, lifetime benefit, out-of-pocket maximum, using J-codes, CPT codes and Diagnosis codes/ route of admin /place of service).