Benefits Verification Specialist

ACU-Serve • 6d ago

As the Benefit Verification and Authorization Analyst I should be a highly self-motivated individual with exceptional organizational and communication skills. You will be responsible for daily intake verification of biologic drugs, actioning prior authorization requests, following up on status requests, and obtaining updated clinical documentation for assigned cases. The Analyst I will work to collaborate with other Analysts and bring questions to Analyst II and Supervisor for review.

Qualifications:

Must have obtained a High School Diploma or GED
Minimally 0-1 years of experience or able to demonstrate expert knowledge and understanding of authorization processes.
Knowledge of CPT and ICD-10/Procedure Codes, Medical policies, LCD’s and Medical terminology.
The ability to interpret patient benefits to include deductibles, copayments, and coinsurance.
Works efficiently to ensure documentation and notification is processed in a timely manner
Professional communication both internally in work environment and externally (customer facing)
Familiarity with HCPCS, J codes and conversions is a preference
Preferred experience with home infusion, specialty therapy billing practices preferred
Preferred experience dealing with commercial and government payers
Knowledge of Microsoft Tools such as Excel, Word, office 365 experience, is a must
Analytical skills with math and clear penmanship is a must

Duties and Responsibilities:

Serve as a liaison between ACU-Serve and our clients ensuring all clinical documentation is obtained to gain procedure authorizations 
Work directly with Payers (Insurance) clients to perform insurance benefits verification for infusion services for assigned clients
Performs pre-certification and obtains authorizations and referrals as required by Payer guidelines
Gathers medical documentation to support the Patients' treatments for further review
Follow-up on pending referrals, pre-certifications, and/or pre-determination
Scan and upload documents from insurance providers into electronic records system and work closely with client and billing once approved
Research and follow up on authorization denials