Experienced Reimbursement Specialist – Healthcare Benefits Verification

Are you a highly motivated and detail-oriented professional with a passion for delivering exceptional customer service in the healthcare industry? Do you have a strong background in medical insurance, specialty pharmacy, or a related field? If so, we invite you to join our dynamic team at blithequark as a Reimbursement Specialist – Healthcare Benefits Verification.

About blithequark

blithequark is a leading provider of innovative solutions in the healthcare industry, dedicated to improving patient outcomes and streamlining reimbursement processes. Our team is comprised of talented professionals who share a common goal: to deliver exceptional service and support to our clients and customers. As a Reimbursement Specialist, you will play a critical role in ensuring that healthcare providers receive accurate and timely reimbursement for their services.

Job Summary

As a Reimbursement Specialist, you will be responsible for verifying patient insurance benefits to ensure that there are no lapses in coverage that could affect ongoing therapy. This involves checking current policy details and confirming that the patient's coverage remains active throughout their treatment period. You will also be responsible for verifying network status and reimbursement rates, confirming that all necessary prior authorizations are in place and valid, and ensuring that any required documentation is submitted correctly.

Key Responsibilities

* Place outbound calls to insurance providers to verify information and verify coverage changes

• Collect and review patient insurance benefit information according to program SOPs
• Complete and submit insurance forms and prior authorizations in a timely manner, ensuring accuracy and adherence to third-party payer requirements
• Provide exceptional customer service to internal and external customers, resolving requests promptly and escalating complaints as needed
• Maintain regular phone contact with provider representatives, third-party customer service reps, and pharmacy staff
• Effectively communicate with payors for benefit investigations and coordinate with inter-departmental associates as necessary
• Process insurance and patient correspondence
• Report reimbursement trends or delays to the supervisor
• Provide all necessary documentation for prior authorizations, including demographic details and relevant identification numbers

Requirements

* 1 year of experience in specialty pharmacy, medical insurance, healthcare setting, and/or related experience

• Must be patient: Hold times may be up to 90 minutes by client requirements
• Must have a private, designated workspace
• Must be MS Office proficient: Excel, Outlook, Word
• Must be flexible on schedule and hours
• Employment verification required: Last 3 employers
• High school diploma or equivalent
• Background check required

Preferred Qualifications

* 2+ years of experience in healthcare benefits verification or a related field

• Experience with CRM software and prior authorization processes
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment with multiple priorities

Training and Development

* Approximately 3 weeks of training, including practice and mock calls

• Various assessments during training, candidates must meet the program score requirements by Dec 31
• Hands-on learning of the CRM, specific client program protocol requirements, cadence, script, and system navigation

Work Environment and Culture

* Fully remote work environment with flexible scheduling

• Collaborative and dynamic team environment
• Opportunities for professional growth and development
• Recognition and rewards for outstanding performance

Compensation and Benefits

* $18.00 per hour, with a $1.00 per hour increase for 2+ years of experience in healthcare benefits verification

• Overtime pay for hours worked beyond 40 hours per week
• Paid training and development opportunities
• Comprehensive benefits package, including health, dental, and vision insurance
• 401(k) retirement plan with company match

How to Apply

If you are a motivated and detail-oriented professional with a passion for delivering exceptional customer service in the healthcare industry, we invite you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, through our online application portal.

Equal Employment Opportunity

blithequark is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and respectful work environment that values diversity, equity, and inclusion.

Contact Information

If you have any questions or would like to learn more about this opportunity, please contact us at [insert contact information]. We look forward to hearing from you! Apply for this job