Job Description

• Receive assigned insurance verification requests (IVR's) from data intake; call Health Plan to obtain benefit coverage levels and prior authorization requirements to determine payer reimbursement; submit required preauthorization/predetermination paperwork to payer
• Initiate contact with Health Plan and follow-up on benefit coverage requests and prior authorizations; identify and escalate issues as they may arise throughout the process
• Enter coverage levels and/or prior authorization requirements for assigned accounts in database (Alfresco)
• Review and correct data entry errors made by data intake team
• Review and work daily pending case reports to ensure prompt processing and closure of IVR's and authorization requests
• Respond to simple, routine questions from physicians, hospitals, outpatient
• Determine if payer already in SalesForce database; if not, research payer on website to obtain demographic information and forward to senior team member for data entry
• facilities/ambulatory care centers, etc. regarding billing, coding procedures, and processes
• Follow HIPAA policies and procedures to ensure compliance
• Report changes/issues in coverage/reimbursement trends to management

• Effectively identifies problems as they occur and takes appropriate steps to solve them in situations where the problem is not difficult or complex
• Refers complex, unusual problems to supervisor

• Under general supervision, exercises some judgement in accordance with well-defined policies, procedures, techniques
• Work typically involves regular review of output by a senior coworker or supervisor

• HS Diploma or GED
• Specialized skill training; certification may be required
• 2-5 years of experience in area of responsibility
• Basic understanding of Medicare, Commercial and Medicaid health plans a plus

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