medical insurance specialist

Drs Rubinstein & Ducoff Inc

<p><b>Job Overview</b><br/>We are seeking a proactive and detail-oriented Medical Insurance Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing insurance authorizations, verifying coverage, and ensuring timely approval for patient services. Your expertise will help streamline the authorization process, reduce delays, and enhance patient care experiences. This position offers an exciting opportunity to work within a dynamic medical environment, utilizing your knowledge of managed care and medical coding to facilitate seamless insurance interactions.</p><p><b>Responsibilities</b></p><ul><li>Obtain prior authorization and pre-certification from insurance providers for oral sleep appliances and follow up appointments</li><li>Verify patient insurance coverage and benefits accurately using insurance portals and verification systems.</li><li>Review medical records, documentation, and clinical notes to support authorization requests in compliance with HIPAA regulations.</li><li>Utilize CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems to prepare accurate documentation for insurance submissions.</li><li>Communicate effectively with healthcare providers, insurance companies, and patients to resolve authorization issues promptly.</li><li>Maintain detailed records of all authorization requests, approvals, denials, and follow-up actions in the medical records system.</li><li>Stay updated on managed care policies, insurance guidelines, and coding changes to ensure compliance and efficiency in the authorization process.</li></ul><p><b>Experience</b></p><ul><li>Prior experience working in a medical office setting or dental office environment is highly preferred.</li><li>Strong knowledge of managed care processes, insurance verification procedures, and medical billing practices.</li><li>Familiarity with HIPAA regulations to ensure patient confidentiality during all interactions.</li><li>Proficiency in medical terminology, medical records management, and medical coding including CPT, ICD-9, ICD-10, and ICD coding systems.</li><li>Experience with insurance authorization workflows within a healthcare or dental office setting is advantageous.</li><li>Excellent organizational skills with the ability to handle multiple tasks efficiently while maintaining attention to detail.</li><li>Office experience demonstrating proficiency with electronic health records (EHR) systems or similar software. Join us in making a difference by ensuring patients receive the care they need without unnecessary delays! We value energetic professionals who are eager to contribute their expertise in managed care and medical coding while providing exceptional service within a collaborative team environment.</li></ul><p>Pay: $24.23 - $29.18 per hour</p><p>Work Location: In person</p>

Medical Insurance Authorization Specialist

Town Center Foot & Ankle

<p>Town Center Foot &amp; Ankle is seeking a reliable and detail-oriented Insurance Verification Specialist to join our growing podiatry practice in Kingwood, TX. In this role, you will be responsible for verifying patients&rsquo; medical insurance benefits and ensuring accurate information is obtained prior to services.</p><p>The ideal candidate is organized, dedicated, and has strong communication skills. While previous experience in insurance verification or medical office settings is preferred, it is not required&mdash;we are willing to train the right candidate.</p><p>This is an excellent entry-level opportunity for someone looking to start a career in healthcare administration, with potential for growth and advancement within our practice.</p><p>Join our team and grow your career in a supportive and professional environment!</p><p><b>Key Qualities:</b></p><ul><li>Strong attention to detail</li><li>Excellent communication and organizational skills</li><li>Dependable and team-oriented attitude</li></ul><p><b>Responsibilities:</b></p><ul><li>Verifying eligibility and benefits by phone and online</li><li>Obtaining referrals and prior authorizations</li><li>Answering phones</li><li>Scheduling appointments</li></ul><p><b>Preferred Experience:</b></p><ul><li>Insurance verification (commercial and Medicare)</li><li>NextGen (MediTouch) EHR</li></ul><p><b>Benefits:</b></p><ul><li>4 day work week (Mon-Thurs)</li><li>401k with company matching</li><li>Paid Time Off</li></ul><p>Job Type: Full-time</p><p>Pay: $13.00 - $16.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Paid time off</li></ul><p>Application Question(s):</p><ul><li>Do you have experience verifying insurance?</li></ul><p>Work Location: In person</p>

Medical Insurance Verification Specialist

AIS HealthCare

<div><div><div><div><div><div><p>This is a 100% remote opportunity; however, please <b>only </b>apply if you have<b>3 to 5 years of medical insurance collections experience</b>.</p>
<p>AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.</p>
<p>AIS Healthcare is looking for experienced and motivated Accounts Receivable Collection experts to join our dynamic team! The AR Collection role is a full-time position responsible for collection processes for TDD services that includes contract analysis, reimbursement, denial management, appeals and resolving billing-related issues with insurance companies or other responsible party for services rendered. The perfect candidate should have an in-depth knowledge of collection practices related to billing and collection activities.</p>
<p>AIS Healthcare offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, and a 401K plan with a generous employer contribution. Additionally, we offer a 100% work from home model.</p>
<p><b>EDUCATION AND EXPERIENCE:</b></p>
<ul><li>A high school diploma or general education degree (GED) equivalent is required.</li>
<li>3-5 years of healthcare industry experience required.</li>
<li>3-5 years of medical billing and collections experience required.</li>
<li>Home Infusion, Intrathecal Pain Management experience preferred.</li>
</ul><p><b>ESSENTIAL DUTIES AND RESPONSIBILITIES:</b></p>
<ul><li>Recognizes patients&rsquo; rights and responsibilities and supports them in the performance of job duties, respects patient&rsquo;s rights to privacy and confidentiality.</li>
<li>Follows up on invoices submitted to ensure prompt and timely payment and escalates issues, as necessary.</li>
<li>Evaluates payments/denials received for correctness and ensures they are applied accordingly.</li>
<li>Identifies bad debt write-offs and A/R adjustments. Initiates write-offs and adjustments in accordance with policies and procedures.</li>
<li>Identifies any overpayments and/or duplicate payments and investigates and resolves accordingly.</li>
<li>Processes refund requests, in accordance with policies and procedures.</li>
<li>Maintains contact with other departments to obtain patient or insurance information needed for claim payment.</li>
<li>Responsible for understanding all procedures within regulatory mandates.</li>
<li>Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol, and are following Federal, State, and payer regulation, guidelines, and requirements.</li>
<li>Makes calls to troubleshoot payment discrepancies and establish resolution.</li>
<li>Documents, in detail, phone calls, phone number, person spoken to, and call details on a consistent basis.</li>
<li>Consistently looks for areas to maximize claim reimbursement.</li>
<li>Resolves issues that created a denial within 5 days of receipt of denial.</li>
<li>Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.</li>
<li>Maintains understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.</li>
<li>Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.</li>
<li>Shares knowledge gained with other staff members and works as a team member.</li>
<li>Interacts with others in a positive, respectful, and considerate manner.</li>
<li>Performs other job-related duties as assigned.</li>
</ul><p><b>QUALIFICATION REQUIREMENTS:</b></p>
<ul><li>Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.</li>
<li>Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.</li>
<li>Strong work ethic with personal qualities of integrity and credibility.</li>
<li>Self-directed, detail oriented, conscientious, organized, and able to follow through.</li>
<li>Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.</li>
<li>Tolerant of frequent interruptions and distractions from staff and other internal support teams.</li>
<li>Proficient in Microsoft Office, including Outlook, Word, and Excel.</li>
</ul><p><b>Steps to Apply:</b></p>
<p>To apply for this role, you must complete a Culture Index Assessment to be considered.<b>Please note that your application will not be considered if the Assessment is not completed.</b></p>
<p>Copy and paste the following link into your browser and press enter. Then, select the corresponding position for which you are applying. (Only one assessment per candidate is required.) The assessment is brief, taking less than ten minutes to complete.</p>
<p>portal.cultureindex.com/public/survey/general/0BFB8F0000</p>
<p><i>AIS HealthCare&trade;</i><i>is the leading provider of advanced sterile, patient-specific intrathecal pump medications and in-home intravenous infusion, including immune globulin therapies. These services, combines with your advanced nursing and care coordination solutions, assist physicians and hospitals in delivering a superior level of care for optimal therapeutic outcomes.</i></p>
<p><i>We offer a wonderful work culture, looking for an impact player who is positive, earnest, and hardworking.</i></p></div></div></div></div></div></div><div></div>

Experienced Medical Insurance Collection Specialist

Concept Pharmacy

<div><h3 class="jobSectionHeader"><b>POSITION:</b></h3>
<p>
Multiple Openings &ndash; Medical Billing, Insurance Specialist, Census, and Prior Authorization</p>
<p></p>
<h3 class="jobSectionHeader"><b>Job Summary:</b></h3>
<p>
Concept Billing Services, a rapidly growing provider of billing solutions to premier regional pharmacies, is seeking skilled and motivated individuals to join our team. We are hiring for <b>multiple positions</b> across our administrative team, including <b>Medical Billing, Insurance Specialist, Census, and Prior Authorization roles</b>.</p>
<p>
While candidates may have experience in one or more of these areas, all new hires will begin in the <b>Census Department</b>for onboarding and training before being placed into the role that best aligns with their skills, experience, and business needs.</p>
<p></p>
<h3 class="jobSectionHeader"><b>Key Responsibilities by Role:</b></h3>
<p><b>
Medical Billing:</b></p>
<ul>
<li><p>Process and submit claims accurately and in a timely manner</p>
</li>
<li><p>Review billing data for completeness and compliance</p>
</li>
<li><p>Follow up on outstanding claims and resolve discrepancies</p>
</li>
</ul><p><b>Insurance Specialist (Billing):</b></p>
<ul>
<li><p>Verify insurance coverage and benefits</p>
</li>
<li><p>Handle claim denials, appeals, and reimbursement follow-ups</p>
</li>
<li><p>Communicate with insurance providers to resolve issues</p>
</li>
</ul><p><b>Census:</b></p>
<ul>
<li><p>Maintain accurate patient/client records and admissions data</p>
</li>
<li><p>Track census changes including admissions, discharges, and transfers</p>
</li>
<li><p>Ensure all required documentation is complete and up to date</p>
</li>
</ul><p><b>Prior Authorization:</b></p>
<ul>
<li><p>Obtain and manage prior authorizations for services</p>
</li>
<li><p>Communicate with insurance companies and internal teams</p>
</li>
<li><p>Ensure timely approvals to avoid delays in care/services</p>
</li>
</ul><p></p><h3 class="jobSectionHeader"><b>Qualifications:</b></h3>
<ul>
<li><p>Experience with pharmacy insurance billing and processing, particularly in a long-term care (LTC) setting, is preferred; however, we are willing to train the right candidate</p>
</li>
<li><p>Proficiency in Microsoft Excel is a plus</p>
</li>
<li><p>Knowledge of PointClickCare (PCC) is preferred but not required</p>
</li>
</ul><p></p><h3 class="jobSectionHeader"><b>Additional Notes:</b></h3>
<ul>
<li><p>All candidates must be willing to start in the <b>Census Department</b> as part of the onboarding process</p>
</li>
<li><p>Final role placement will be determined based on experience, performance, and organizational needs</p>
</li>
</ul><p></p><h3 class="jobSectionHeader"><b>Why Join Concept Billing Services?</b></h3>
<p>
We value our employees and offer a comprehensive benefits package, including:</p>
<ul>
<li><p>Medical insurance</p>
</li>
<li><p>Paid vacation time</p>
</li>
<li><p>Paid holidays</p>
</li>
<li><p>401(k) retirement plan</p>
</li>
</ul><p>Become part of a supportive and dynamic team in a growing organization dedicated to delivering top-tier billing services&mdash;now at our <b>new location</b>.</p>
<p></p>
<h3 class="jobSectionHeader"><b>Apply Today!</b></h3>
<p>
Take the next step in your career with Concept Billing Services. We look forward to hearing from you!</p><br>
<p></p>
<p>
XQ2CPPB</p></div><p></p>

Multiple Openings: Medical Billing, Insurance Specialist, Prior Authorization & Census

Onco360

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for a <b>Lead Medical Benefits Verification Specialist</b> for our Pharmacy located in Waltham, MA.</div>
<div></div><div><b>Work Hours: Monday-Friday 8:30 - 5:00pm EST</b></div>
<div></div><div><b>**Starting salary at $29/hr** </b>We also offer quarterly incentive bonuses.</div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
<div></div><div><b>Lead Medical Benefits Verification Specialist Summary:</b></div>
<div>The Lead Medical Benefits Verification Specialist is responsible to support the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Lead will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. Support the department's Manager with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified.</div>
<div></div><div><b>Lead Medical Benefits Verification Specialist Major Responsibilities:</b></div>
<div><ul><li>Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services. Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profiles. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).</li>
<li>Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions. Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices. Identify the appropriate clinical records and</li>
<li>submit the authorization request to the insurance company based on plan requirements for approval.</li>
<li>Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.</li>
<li>Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
<li><div>Lead process improvement: Analyze workflows, identify opportunities for improvement, and implement more efficient procedures to reduce turnaround times and improve accuracy. Assist the Medical Verification Specialists in achieving: &gt;95% accuracy/quality while handling accounts, as measured by account audits &gt;95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards assist the manager of the department with escalated issues, tracking system and process issues.</div>
 </li><li><div>Mentor and train staff: Guide and train junior specialists on proper benefit verification and claim processing procedures.</div>
</li><li><div>Ensure compliance: Adhere to all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain patient confidentiality.</div>
</li><li><div>Performs other duties as assigned.</div>
</li></ul></div><div><b>Education/Learning Experience</b></div>
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul><div><b>Work Experience</b></div>
<ul><li>Required:
<div>3+ years&rsquo; Medicare and Medical benefit verification experience</div>
</li><li><div>Desired: 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience</div>
</li></ul><div><b>Skills/Knowledge</b></div>
<ul><li>Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
<li>Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience</li>
</ul><div><b>Licenses/Certifications
</b></div><ul><li>Required: None</li>
<li>Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)</li>
<li><div>Certified Revenue Cycle Representative (CRCR)</div>
<div>Certified Medical Insurance Specialist (CMIS)</div>
</li></ul><div></div><div><b>Behavior Competencies</b></div>
<ul><li>Required: Independent worker, self-motivated<br>
Analytical skills: The ability to interpret complex insurance documents and identify potential gaps in coverage is crucial for handling more difficult cases.<br>
Communication: Excellent verbal and written communication skills are essential for interacting with insurance companies, patients, and other healthcare professionals.<br>
Problem-solving: Senior specialists must possess strong problem-solving skills to efficiently address and resolve insurance-related issues.<br>
Technical proficiency: Expertise in electronic health record (EHR) systems, insurance verification software, and payer portals is necessary.<br>
Leadership abilities: The capacity to mentor junior staff and lead process improvement projects is a key differentiator for a senior role.</li>
</ul>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div>A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.</div>
<div></div><div>We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.</div></div>

Lead Medical Benefits Verification Specialist

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for a <b>Lead Medical Benefits Verification Specialist</b> for our Pharmacy located in <b>Buffalo, NY.</b></div>
<div></div><div><b>Work Hours: Monday-Friday 8:30 - 5:00pm EST</b></div>
<div></div><div><b>**Starting salary at $25/hr** </b>We also offer quarterly incentive bonuses.</div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
<div></div><div><b>Lead Medical Benefits Verification Specialist Summary:</b></div>
<div>The Lead Medical Benefits Verification Specialist is responsible to support the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Lead will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. Support the department's Manager with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified.</div>
<div></div><div><b>Lead Medical Benefits Verification Specialist Major Responsibilities:</b></div>
<div><ul><li>Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services. Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profiles. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).</li>
<li>Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions. Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices. Identify the appropriate clinical records and</li>
<li>submit the authorization request to the insurance company based on plan requirements for approval.</li>
<li>Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.</li>
<li>Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
<li><div>Lead process improvement: Analyze workflows, identify opportunities for improvement, and implement more efficient procedures to reduce turnaround times and improve accuracy. Assist the Medical Verification Specialists in achieving: &gt;95% accuracy/quality while handling accounts, as measured by account audits &gt;95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards assist the manager of the department with escalated issues, tracking system and process issues.</div>
 </li><li><div>Mentor and train staff: Guide and train junior specialists on proper benefit verification and claim processing procedures.</div>
</li><li><div>Ensure compliance: Adhere to all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain patient confidentiality.</div>
</li><li><div>Performs other duties as assigned.</div>
</li></ul></div><div><b>Education/Learning Experience</b></div>
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul><div><b>Work Experience</b></div>
<ul><li>Required:
<div>3+ years&rsquo; Medicare and Medical benefit verification experience</div>
</li><li><div>Desired: 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience</div>
</li></ul><div><b>Skills/Knowledge</b></div>
<ul><li>Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
<li>Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience</li>
</ul><div><b>Licenses/Certifications
</b></div><ul><li>Required: None</li>
<li>Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)</li>
<li><div>Certified Revenue Cycle Representative (CRCR)</div>
<div>Certified Medical Insurance Specialist (CMIS)</div>
</li></ul><div></div><div><b>Behavior Competencies</b></div>
<ul><li>Required: Independent worker, self-motivated<br>
Analytical skills: The ability to interpret complex insurance documents and identify potential gaps in coverage is crucial for handling more difficult cases.<br>
Communication: Excellent verbal and written communication skills are essential for interacting with insurance companies, patients, and other healthcare professionals.<br>
Problem-solving: Senior specialists must possess strong problem-solving skills to efficiently address and resolve insurance-related issues.<br>
Technical proficiency: Expertise in electronic health record (EHR) systems, insurance verification software, and payer portals is necessary.<br>
Leadership abilities: The capacity to mentor junior staff and lead process improvement projects is a key differentiator for a senior role.</li>
</ul>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div>A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.</div>
<div></div><div>We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.</div></div>

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for a <b>Lead Medical Benefits Verification Specialist</b> for our Pharmacy located in <b>Houston, TX.</b></div>
<div></div><div><b>Work Hours: Monday-Friday 8:30 - 5:00pm CST</b></div>
<div></div><div><b>**Starting salary at $23/hr** </b>We also offer quarterly incentive bonuses.</div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
<div></div><div><b>Lead Medical Benefits Verification Specialist Summary:</b></div>
<div>The Lead Medical Benefits Verification Specialist is responsible to support the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Lead will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. Support the department's Manager with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified.</div>
<div></div><div><b>Lead Medical Benefits Verification Specialist Major Responsibilities:</b></div>
<div><ul><li>Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services. Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profiles. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).</li>
<li>Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions. Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices. Identify the appropriate clinical records and</li>
<li>submit the authorization request to the insurance company based on plan requirements for approval.</li>
<li>Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.</li>
<li>Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
<li><div>Lead process improvement: Analyze workflows, identify opportunities for improvement, and implement more efficient procedures to reduce turnaround times and improve accuracy. Assist the Medical Verification Specialists in achieving: &gt;95% accuracy/quality while handling accounts, as measured by account audits &gt;95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards assist the manager of the department with escalated issues, tracking system and process issues.</div>
 </li><li><div>Mentor and train staff: Guide and train junior specialists on proper benefit verification and claim processing procedures.</div>
</li><li><div>Ensure compliance: Adhere to all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain patient confidentiality.</div>
</li><li><div>Performs other duties as assigned.</div>
</li></ul></div><div><b>Education/Learning Experience</b></div>
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul><div><b>Work Experience</b></div>
<ul><li>Required:
<div>3+ years&rsquo; Medicare and Medical benefit verification experience</div>
</li><li><div>Desired: 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience</div>
</li></ul><div><b>Skills/Knowledge</b></div>
<ul><li>Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
<li>Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience</li>
</ul><div><b>Licenses/Certifications
</b></div><ul><li>Required: None</li>
<li>Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)</li>
<li><div>Certified Revenue Cycle Representative (CRCR)</div>
<div>Certified Medical Insurance Specialist (CMIS)</div>
</li></ul><div></div><div><b>Behavior Competencies</b></div>
<ul><li>Required: Independent worker, self-motivated<br>
Analytical skills: The ability to interpret complex insurance documents and identify potential gaps in coverage is crucial for handling more difficult cases.<br>
Communication: Excellent verbal and written communication skills are essential for interacting with insurance companies, patients, and other healthcare professionals.<br>
Problem-solving: Senior specialists must possess strong problem-solving skills to efficiently address and resolve insurance-related issues.<br>
Technical proficiency: Expertise in electronic health record (EHR) systems, insurance verification software, and payer portals is necessary.<br>
Leadership abilities: The capacity to mentor junior staff and lead process improvement projects is a key differentiator for a senior role.</li>
</ul>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div>A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.</div>
<div></div><div>We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.</div></div>

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