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Insurance Verification Specialist - Level 1

Company: Walgreens
Location: Pittsburgh
Posted on: September 14, 2020

Job Description:

Job Description:

The Specialist Insurance Verification is responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility for services including, but not limited to, major medical insurance benefits (including Medicare), complex insurance plans, and high volume PBM plans. This position needs to understand the authorization process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical, and PBM.

Job Responsibilities

* Utilizes all available resources to obtain and enter insurance coverage information for ordered services; Verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits (including Medicare) or pharmacy benefits; Facilitates and completes the prior authorization process with insurance companies and practitioner offices

* Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices; Investigates and facilitates prior authorization and any other claim rejections

* Notifies patients, physicians, practitioners, and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility

* Communicates with other departments and senior managers as necessary to facilitate urgent needs; Places outbound calls to patients or physicians' offices to obtain additional information needed to process requests; Manages inbound calls on the insurance line from patients, clients, physicians, practitioners, and clinics regarding inquiries about services provided, financial responsibility, and insurance coverage

* Other responsibilities as judgment or necessity dictate

Keywords: Walgreens, Pittsburgh , Insurance Verification Specialist - Level 1, Other , Pittsburgh, Pennsylvania

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