Job Details

Position Purpose:
Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits

Education/Experience:
High school diploma with 1+ years of medical billing or insurance verification experience. Bachelor'sdegree in related field can substitute for experience. Experience with payors and prior authorization preferred.

Foundation Care Only: Missouri Registered Pharmacy Technician is preferred, but not required

Obtain and verify insurance eligibility for services provided and document complete information in system

Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies

Collect any clinical information such as lab values, diagnosis codes, etc.

Determine patient's financial responsibilities as stated by insurance

Configure coordination of benefits information on every referral

Ensure assignment of benefits are obtained and on file for Medicare claims

Bill insurance companies for therapies provided

Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures

Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs

Handle inbound calls from patients, physician offices, and/or insurance companies

Resolve claim rejections for eligibility, coverage, and other issues
Performs other duties as assigned

Complies with all policies and standards

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."

Position Purpose: Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits

Education/Experience: High school diploma with 1+ years of medical billing or insurance verification experience. Bachelor's degree in related field can substitute for experience. Experience with payors and prior authorization preferred. Strong customer service skills.

Responsibilities:
• Obtain and verify insurance eligibility for services provided and document complete information in system
• Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies
• Collect any clinical information such as lab values, diagnosis codes, etc.
• Determine patient's financial responsibilities as stated by insurance
• Configure coordination of benefits information on every referral
• Ensure assignment of benefits are obtained and on file for Medicare claims
• Bill insurance companies for therapies provided
• Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures
• Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs
• Handle inbound calls from patients, physician offices, and/or insurance companies
• Resolve claim rejections for eligibility, coverage, and other issues Story Behind the Need

• What is the purpose of this team?
• Describe the surrounding team (team culture, work environment, etc.) & key projects.
• Do you have any additional upcoming hiring needs or is this request part of a larger hiring initiative?

project ascend

Typical Day in the Role

• Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
• What are the performance expectations/metrics?
• What makes this role unique?

Insurance verification for medication; prior authorization appeals; speak to patients, doctors' offices, & insurance plans
Inbound internal que
25 referrals/more a day
95% quality or higher
ttendance is crucial

The IV experience we are looking for is them actually obtaining the benefits from the health plan and providing to the patient. For the PA side, we're looking for experience with the candidates submitting the PA themselves.

We would like to see the candidate's resumes accurately reflect whether they actually verified benefits/submitted PA's, showcase professionalism Candidate Requirements Education/Certification Required: High school diplom Preferred: N Licensure Required: N Preferred: Years of experience required: 1 + years of experience

Disqualifiers: N

dditional qualities to look for: Proficient in Microsoft Office, experience/backgrounds that do well in this role- Managed Care, Pharmacy, Medical terminology, Physician office experience, Customer Service, Call Center

• Top 3 must-have hard skills stack-ranked by importance

1 Managed Care 2 Customer Service 3 Call Center Candidate Review & Selection

• Shortlisting process
• Candidate review & selection
• Interview information
• Onboard process and expectations

Projected Manager Candidate Review Date: 1-2 days post shortlisting