Benefits and Authorizations Specialist Lead

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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