Insurance Verification Representative

Overview

• Support a healthcare organization by verifying insurance coverage for patient treatments and services.
• Ensure accurate eligibility checks for commercial plans, Medicare, Medicaid, and managed care policies.
• Collaborate with healthcare teams to streamline patient access to necessary treatments.
• Gain valuable experience in prior authorization processes and payer-specific requirements.
• Enhance knowledge of medical coding standards, including J-codes, CPT/HCPCS codes, and ICD-10.
• Contribute to the efficient operation of healthcare services in a supportive environment.
• Develop professional skills and advance your career in healthcare administration.

Key Responsibilities & Duties

• Verify insurance benefits, eligibility, and coverage details for patient treatments.
• Utilize payer portals to obtain prior authorizations for medications and procedures.
• Interpret clinical documentation and physician orders for accurate insurance processing.
• Collaborate with healthcare teams to ensure compliance with payer policies and regulations.
• Maintain knowledge of medical coding standards and treatment protocols.
• Assist in managing insurance requirements for various payer types and plans.
• Provide support for authorization processes related to adjunct drugs and infusion services.
• Contribute to the accuracy and efficiency of patient care services.

Job Requirements

• High School Diploma or GED required; certifications in healthcare or insurance preferred.
• Minimum of 1 year of experience in insurance verification; 3 years preferred.
• Proficiency in prior authorization processes and payer-specific requirements.
• Knowledge of medical coding standards, including J-codes, CPT/HCPCS codes, and ICD-10.
• Ability to interpret clinical documentation and physician orders accurately.
• Strong organizational and communication skills for effective collaboration.
• Familiarity with commercial plans, Medicare, Medicaid, and managed care policies.
• Commitment to maintaining compliance with healthcare regulations and standards.