As an Insurance Verification Representative, you will be responsible for obtaining required documentation in compliance with governmental and commercial payer requirements in order to ensure the reimbursement of services provided to patients. You will review requests from doctors and pharmacists to determine whether prior authorization of medication coverage can be given; this will be accomplished by screening and reviewing requests based on benefit plan design, client specifics, and clinical criteria.
Other responsibilities of the Prior Authorization role include:
- Verifying insurance benefits for commercial and governmental payers
- Obtaining insurance authorizations in a timely manner for equipment/services provided
- Handling inbound telephone and written inquiries from pharmacists and doctors
- Screening and reviewing requests based on benefit plan design, client specifics, and clinical criteria
- Providing information to clients, participants, pharmacists, and doctors regarding participants pharmacy benefits and drug coverage
- Providing accurate procedures for medication exceptions
- Facilitating resolution of drug coverage issues and proactively resolving issues
- Maintaining accurate and complete documentation of all inquiries for continuous improvement
As an Insurance Verification Representative, you must be able to work independently, prioritize tasks, and stay organized in a high volume, inbound call center setting. You must have excellent communication and organizational skills with the ability to multitask and collaborate in a team-oriented environment.
Other requirements of the Prior Authorization role include:
- High school diploma or equivalent certification
- Previous administrative clerical or related experience
- Previous Prior Authorization Representative experience, a plus
- Knowledge of medical terminology
- Computer skills and experience with Microsoft Office Applications
In order to be eligible for health benefits, you must be employed for 30 days and must average 30 hours per week for four consecutive weeks.
As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy:
- 401(k) Retirement Plan
- Medical, dental and vision plan with American Worker
- Prescription Programs
- Term Life Insurance Plan