medicare insurance specialist

Key Family of Companies

<div>Senior Connection is looking for a customer‑focused Medicare Retention Specialist to support our existing clients, help them evaluate their Medicare coverage, and ensure they continue to receive exceptional service year after year. This rewarding role helps keep our clients informed, engaged, and confident in their healthcare decisions. A valid Indiana Life and Health license is required. This full-time position is based in our Evansville, IN office and includes a full benefits package along with commission and bonus opportunities.<br>
<b>Position Summary:</b> The <b><i>Medicare Retention Specialist</i></b> is responsible for supporting and retaining existing Medicare clients by delivering exceptional service, conducting ongoing plan reviews, and proactively identifying opportunities to improve client coverage satisfaction. The specialist assists clients with evaluating Medicare Advantage, Supplement, and Prescription Drug Plan (PDP) options and facilitates applications for new coverage when appropriate.<h2 class="jobSectionHeader"><b>
What You'll Do:</b></h2><ul><li>
Build relationships with existing Medicare clients through ongoing outreach and exceptional service.</li><li>
Review clients' current Medicare plans and help them evaluate new or alternative coverage options.</li><li>
Assist clients with Prescription Drug Plan (PDP) reviews and annual plan updates.</li><li>
Support clients through enrollment processes during AEP, OEP, and Special Enrollment Periods.</li><li>
Track and report key retention metrics and client engagement activities.</li><li>
Identify potential retention risks and share insights with leadership.</li><li>
Partner with sales agents by managing client service needs so they can focus on new business.</li></ul><h2 class="jobSectionHeader"><b>
A Day in the Life:</b></h2><p>
Each day you'll connect with current clients-by phone, email, or scheduled appointments-to review their coverage, answer questions, and help them feel supported. You'll complete plan reviews, document interactions in our systems, and work closely with the sales team to ensure clients receive the ongoing care and attention they deserve. It's a role where relationship‑building, problem‑solving, and making someone's day all come standard.</p><h2 class="jobSectionHeader"><b>
What Success Looks Like:</b></h2><ul><li>
High Client Satisfaction: Clients feel supported, informed, and valued, resulting in strong satisfaction scores and positive feedback.</li><li>
Improved Retention Rates: A measurable increase in the percentage of clients renewing or maintaining their Medicare plans year over year.</li><li>
Proactive Engagement: Consistent and timely outreach to all assigned clients, including completion of annual plan reviews and drug plan assessments.</li><li>
Effective Issue Resolution: Client concerns and coverage questions are addressed quickly and accurately.</li><li>
Strong Collaboration: Sales agents experience reduced administrative load, allowing them to remain focused on new business, while the retention specialist ensures existing clients receive exceptional service.</li></ul><h2 class="jobSectionHeader"><b>
About Senior Connection</b></h2><p>
For more than <b>35 years</b>, Senior Connection has proudly served Medicare beneficiaries throughout the Evansville community and around the country. We are a locally rooted agency built on trust, personal relationships, and a commitment to helping clients navigate their healthcare choices with confidence. Our team is dedicated to providing knowledgeable guidance and friendly, reliable support-because to us, our clients are family.</p><p>
Learn More: https://seniorconnectionbenefits.com/</p></div>

Medicare Retention Specialist

Independent Living Systems, llc

<div><p>We are seeking a Medical Sales Agent to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.</p><p><b>
About the Role:</b></p><p>
As a Medicare Sales Agent, you will play a critical role in guiding eligible individuals through the complex landscape of Medicare insurance options to help them make informed decisions that best suit their healthcare needs. Your primary objective will be to educate clients on various Medicare plans, including Part A, Part B, Part C, and Part D, ensuring they understand coverage details, benefits, and costs. You will build and maintain strong relationships with clients by providing personalized service and ongoing support throughout the enrollment process and beyond. This role requires a deep understanding of Medicare regulations and the ability to stay current with policy changes to provide accurate and compliant advice. Ultimately, your efforts will contribute to improving clients' access to essential healthcare coverage while driving sales growth for your organization.</p><p><b>
Minimum Qualifications:</b></p><ul><li>
Valid health insurance license as required by the state of residence.</li><li>
Demonstrated knowledge of Medicare products and regulations.</li><li>
Proven experience in sales, preferably in the insurance or healthcare industry.</li><li>
Strong communication and interpersonal capabilities.</li><li>
Ability to pass background checks and comply with all regulatory requirements.</li></ul><p><b>
Preferred Qualifications:</b></p><ul><li>
Experience working with senior populations or Medicare beneficiaries.</li><li>
Familiarity with CRM software and sales tracking tools.</li><li>
Certification in Medicare sales or related continuing education courses.</li><li>
Bilingual abilities, especially in Spanish, to better serve diverse client populations.</li><li>
Strong organizational capabilities and the ability to manage multiple client accounts simultaneously.</li></ul><p><b>
Responsibilities:</b></p><ul><li>
Conduct detailed consultations with prospective clients to assess their Medicare insurance needs and preferences.</li><li>
Explain the features, benefits, and costs of various Medicare plans, including Original Medicare, Medicare Advantage, and Prescription Drug Plans.</li><li>
Assist clients with the enrollment process, ensuring all paperwork is completed accurately and submitted on time.</li><li>
Maintain up-to-date knowledge of Medicare policies, regulations, and plan offerings to provide compliant and accurate information.</li><li>
Develop and implement sales strategies to meet or exceed individual and team sales targets.</li><li>
Build and nurture long-term relationships with clients through regular follow-ups and exceptional customer service.</li><li>
Collaborate with internal teams and external partners to resolve client issues and improve service delivery.</li><li>
Document all client interactions and maintain accurate records in compliance with company and regulatory standards.</li></ul></div><p></p>

Medicare Sales Agent

Parallon

<p></p><div><p><b>Introduction</b></p>
<p>Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Technology Specialist WFH opening with Parallon today and find out what it truly means to be a part of the HCA Healthcare team.</p>
<p><b>Benefits</b></p>
<p>Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p>
<ul><li>Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance.</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more</li><li>
Consumer discounts through Abenity and Consumer Discounts</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships)</li><li>
Colleague recognition program</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul>
<p>Learn more about Employee Benefits</p>
<p><b><i>Note: Eligibility for benefits may vary by location.</i></b></p>
<p>We are seeking a Technology Specialist for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!</p>
<p></p><p><b>Job Summary</b>
<br>
The Technology Specialist is responsible for monitoring and performing the execution of existing daily billing system processes and claim update automation jobs necessary for successful business operations. The role will eventually build and modify ad hoc automations. This role should be able to operate with a modest amount of management oversite and to complete assigned tasks, prioritize assignments, research and develop updated procedures and be proactive under the guidance of fellow team members.<br>
<br>
<br>
</p><p><b>Schedule: Monday-Friday Day Shift 6:30a &ndash; 3:00p</b></p><p></p>
<b>Duties include but are not limited to:</b>
<p></p><ul><li>Execute billing system processes and automation jobs.
</li><li>Evaluate outcomes and data to troubleshoot job failures and anomalies.
</li><li>Submit monthly reporting totals.
</li><li>Utilize and maintain ticket tracking software (ServiceCentral and eSAF)
</li><li>Document internal procedures, to included creating new and updating existing procedures to streamline processes.
</li><li>Participates in efforts to improve operational processes and procedures.</li><li>
Performs other duties as assigned.
</li><li>Experience working in SharePoint Online sites is preferred but not necessary.</li></ul><p><b>
Qualifications</b></p><p></p><ul><li>
Working knowledge of Windows operating systems</li><li>
Working knowledge of MS office suite</li><li>
Excellent communication and customer service skills.</li><li>
Attention to detail, quality and accuracy of the tasks performed.</li><li>
Demonstrated discretion while handling confidential or personal data.</li><li>
Strong analytical, problem-solving, and conceptual skills.</li><li>
Ability to accurately and professionally document job processes.</li></ul><p></p><p><b>
Parallon</b> provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.</p>
<p>HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p>
<p>&quot;Across HCA Healthcare&rsquo;s more than 2,000 sites of care, our nurses and colleagues have a positive impact on patients, communities and healthcare.<br>
Together, we uplift and elevate our purpose to give people a healthier tomorrow.&quot;- Jane Englebright, PhD, RN CENP, FAAN<br>
Senior Vice President and Chief Nursing Executive</p>
<p>If you find this opportunity compelling, we encourage you to apply for our Technology Specialist WFH opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. <b>We are interviewing apply today!</b></p>
<p><i>We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div>

Medicare Claims Technology 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

Surface Financial Group, Inc

<p>We are looking for a people that have the heart of a teacher and the compassion of a nurse wanting to make a difference in peoples lives, get paid for what you are worth, and have plenty of time for your family. No matter your background, we will give you the training and support to help you build your book of business. Your attitude, hard work, determination will be the only limiting factors to your level of success.</p><p><b>Responsibilities</b></p><ul><li>Develop marketing strategies and promote new insurance contracts or suggest additions/changes to existing ones</li><li>Breed productive relationships to create a pool of prospective clients from various sources by networking, using referrals and leads</li><li>Evaluate individual customers&rsquo; needs and financial status and propose protection plans that meet their criteria</li><li>Report the progress of monthly/quarterly initiatives</li><li>Maintain bookkeeping systems, database and records</li><li>Achieve customer acquisition and revenue growth objectives</li><li>Constantly update job knowledge and learn about new products and services</li><li>Fulfill all policy requirements</li></ul><p><b>Skills</b></p><ul><li>Ability to get licensed and certified to sell insurance products</li><li>Basic computer and software knowledge</li><li>Proven ability to work with goals</li><li>Demonstrated ability to communicate, present, influence and sell effectively</li><li>Experience in delivering client-focused solutions and in creating long-lasting relationships</li></ul><p>Job Type: Permanent</p><p>Pay: $40,000.00 - $250,000.00 per year</p><p>Benefits:</p><ul><li>Flexible schedule</li></ul><p>License/Certification:</p><ul><li>Life and Health Insurance License (Required)</li></ul><p>Work Location: In person</p>

Medicare Insurance Agent

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 <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>

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>New Hyde Park, 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 $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>

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