Specialist, Authorization

Job Title

Insurance Verification Specialist

ON SITE - Wethersfield, CT

Verifies insurance/managed care plans for eligibility for all of the insurance plans listed in the patient account and documents information in TxM and Athena.

Uses Athena to confirm eligibility and/or contacts the payer directly and documents the outcome in the patient account.

Obtain prior authorizations for each infusion plan listed on each day in a timely manner to as not to delay treatment for patients.

Will pre-certify all patient infusions and injections by confirming their insurance/managed care plan eligibility in addition to confirming whether prior authorization for visits and treatments are necessary.

Advises staff of any insurance plan updates.

Authorize specialty pharmacy drugs for patients and maintains an accounting through the PBM log system.

• High School graduate or equivalent
• Prior medical office experience required
• Prior Authorization Certified Specialist (PACS) preferred
• Knowledge of insurance company/managed care organization constraints related to the retinal practice's office procedures, visits, testing and drug therapy.
• Prior authorization experience of one year strongly preferred
• Must have a high level of customer service, interpersonal and organizational skills
• Must be able to multi-task and handle a fast-paced busy environment
• Strong working knowledge of basic computer programs, and good typing skills
• Ability to plan, prioritize, and complete delegated tasks in a reasonable span of time
• Ability to work independently and as a member of a team
• This position may require cross-coverage of other positions, as needed, and therefore a measure of flexibility to respond adequately to changing demands is required

This is a non-exempt position. The base compensation range for this role is $16.22- $23.00 per hour. At VillageMD, compensation is based on several factors including, but not limited to education, work experience, certifications, location, etc. The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan.