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 daily functions of the Insurance Verification Coordinator includes verification of insurance coverage, re-verifying coverage for existing patients, enter and update patient demographics into the computer system, and securing reimbursement related paperwork for our specialty infusions. Generate price/coverage quotes. Acts as the point of contact for Account Manager insurance verification, referrals and authorizations.
Responsibilities
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Meets turnaround expectations for specialty infusions as directed by the business.
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Work effectively and maintain expected productivity.
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Enter and update patient demographics into the computer system.
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Verify insurance coverage, calculate costs and document details in the patient profile.
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Medical vs pharmacy benefit determination.
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Coordinates and communicates with Account Manager and other single points of contact to expedite insurance checks, authorizations and referrals.
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Meets turnaround expectations for specialty infusions as directed by the business.
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Generate a financial responsibility letter.
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Review benefits with patient via phone.
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Identify copay/foundation assistance and/or donated drug.
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Track, monitor and secure necessary insurance documents.
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Work with the authorizations and patient advocacy teams to coordinate a complete benefit investigation review.
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Coordinate completion of Financial Assistance forms, payment agreements and waivers, as needed.
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Organize and prioritize tasks to be completed.
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Give high priority to client satisfaction and customer needs.
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Cooperate with other staff members when planning and organizing reimbursement activities.
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Demonstrates the ability to work effectively and maintain expected productivity.
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Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks.
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Assist with researching reimbursement issues, as needed.
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Performs in accordance with system-wide competencies/behaviors.
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Performs other duties as assigned.
Skills & Abilities
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Excellent written and verbal communication
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Organization
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Time Management
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Professional
Requirements
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HS diploma or GED required.
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3+ years of insurance verification, prior authorization or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting required.
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Extensive specialty infusion experience with payers covering a 50-state strategy, preferred.
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Knowledge of medical terminology required.
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Knowledge of payer websites, eligibility, and coordination of benefits required.
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Knowledge of pharmacy vs medical payers and authorization required.
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Knowledge of plan formularies and authorization requirements required.
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Proficient computer skills and Microsoft Office Products required.
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Excellent math skills.
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.
What We Do
CarepathRx is transforming pharmacy care delivery for health systems and hospitals, delivering improved patient outcomes that drive clinical, quality and financial results.
CarepathRx provides the industry’s most comprehensive hospital pharmacy care delivery model, providing support across the patient’s complete healthcare journey—across multiple care settings, from hospital to home, no matter the patient acuity level.
We take an enterprise approach to pharmacy care delivery, providing a powerful combination of technology, market-leading clinical pharmacy services, and wrap-around services. This comprehensive, end-to-end approach enables health systems and hospitals to optimize pharmacy performance across the entire enterprise, including:
- Fully integrated pharmacy operations
- Expanded healthcare services
- Improved ambulatory access
- Minimized clinical variation
- Enhanced clinical patient outcomes
- New revenue streams
- Optimized health system revenue growth
For patients this means a more seamless experience and better overall health. And for clients, it means pharmacy is no longer a cost center—it’s a results generator. Today, CarepathRx works with more than 15 health systems and 600 hospitals nationwide.
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