Benefits and Authorizations Specialist Lead
Nira MedicalNeurological Care company
RemoteLead
JSL Health Capital
Silversmith Capital Partners
SV Health Investors
Transformation Capital
Operations & Strategy
About the role
TL;DR
Ensures patients receive coverage for medical and infusion services provided.
- •The Benefits Specialist Lead ensures patients receive coverage for medical and infusion services provided.
- •Key Responsibilities Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
- •Obtains insurance authorization and pre-certification for office visits and infusion services.
- •Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
- •Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
- •Calculate and communicate patient financial responsibility.
- •Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
- •Requirements High school diploma or equivalent 2-3 years of experience in medical insurance verification and prior authorizations.
- •Experience in infusion services is preferred.
- •Knowledge of insurance terminology, plan types, structures, and approval types Previous experience with J-codes, CPT and ICD-10 coding Previous Athena use a plus, but not a requirement Knowledge of medical terminology and clinical documentation review Strong organizational skills Detail-oriented Ability to multi-task and work well in a fast-paced setting Critical thinking skills and decisive judgment
Nice-to-have skills
Athena
Domain expertise
healthcare