Insurance Verification Coordinator I

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

The Insurance Verification Manager oversees the daily operations of the Insurance Verification team, focusing on Specialty Benefit Verification. Responsibilities include verifying insurance coverage, re-verifying coverage for existing patients, updating patient demographics in the system, and securing necessary reimbursement-related documentation. The role also involves generating price/coverage quotes and coordinating with various departments to ensure seamless reimbursement processes.

Responsibilities

• Ensure effective performance and maintain productivity standards.

• Enter and update patient demographics in the system accurately.

• Verify insurance coverage, calculate costs, and document details in patient profiles.

• Generate financial responsibility letters and review benefits with patients via phone.

• Track, monitor, and secure essential insurance documents, including prior authorizations.

• Assist patients with completing Financial Assistance forms, payment agreements, and waivers.

• Provide training support to new employees.

• Organize and prioritize tasks for timely completion.

• Create new hospital and physician codes as needed.

• Prioritize client satisfaction and respond to customer needs.

• Collaborate with staff in organizing and managing reimbursement activities.

• Maintain quality standards, demonstrating reliability, follow-through, and pride in performance.

• Assist in researching reimbursement issues.

• Adhere to system-wide competencies and behaviors.

• Perform other duties as assigned.

Skills & Abilities

• Excellent verbal and written communication skills

• Strong organizational and time-management abilities

• Professional demeanor and conduct

• Attention to detail and problem-solving skills

Qualifications

• High school diploma or GED required.

• 1+ year of experience in insurance verification, prior authorization, or a related field within a healthcare setting (e.g., physician practice, ancillary provider) required.

• Strong knowledge of medical terminology and payer processes.

• Familiarity with payer websites, eligibility verification, and coordination of benefits preferred.

• Knowledge of pharmacy vs. medical payers and plan formularies is a plus.

• Proficiency in computer skills and Microsoft Office products required.

• Excellent mathematical skills required.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.