Insurance Verification Representative

Responsible for verifying patient eligibility, coordinating benefits, 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. Also  responsible for the coordination of benefits investigation and partnering with patient assistance programs.

Essential Functions:

• 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. 

• 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 any other insurance 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.