Biologics and Medications Insurance Specialist

Position Summary

Responsible for verifying insurance coverage and obtaining appropriate insurance authorizations for all scheduled biologics, infusion and other injectable medications for new and established patients.

Essential Duties

• Serves as point of contact for authorizations and related insurance questions for all biologics, infusion and medications.
• Reviews, prioritizes and completes authorizations and referral requests of medications daily for patients. Manages tight deadlines and maintains constant communication with Clinic to ensure timely approval of services and avoid missed authorizations.
• Responsible for the identification and proper data entry of insurance demographics. Verifies specialty outpatient and inpatient insurance, both primary and secondary coverage (when applicable by service type), within set timeframes determined by Administrative Services Management. Verification includes obtaining and documenting covered and non-covered benefits, plan type, co-payment, co-insurance, out of pocket, and deductible amounts and determining contract and benefit eligibility.
• Responsible for notifying the Patient Financial Counseling Office of any significant gaps in coverage and / or high co-pays or deductibles prior to services being rendered. Coordinates drug co-pay assistance programs with Clinic and Patient Financial Counseling Office.
• Documents authorizations or denied authorizations in appropriate systems as per department protocol. Responsible for conducting clinical screening and providing all required medical information to insurance companies, as necessary to facilitate the authorization process.
• Maintains a thorough understanding of all major insurance plans and medications prescribed by National Jewish and medical terminology and coding practices.
• Educates clinical team regarding patient insurance requirements and limitations.
• Maintains communications with patients to keep them apprised of their insurance authorization and eligibility status. Acts as a problem solver with patients regarding their insurance plan.
• Coordinates the authorization appeal process for medications that are deemed not medically necessary. Refers cases requiring additional clinical review to National Jewish faculty and plan directors to ensure medications have all necessary approvals before administrating medications.
• Coordinates retroactive authorizations with medical staff, ancillary departments and insurance plans as necessary.

Competencies

Supervisory or Managerial Responsibility

None

Travel

None

Core Values

Minimum Qualifications

Salary Range : $22.76 - $30.10

Benefits

At National Jewish Health, we recognize that our outstanding faculty and staff are the essence of our organization. For every aspect of health care, our employees are our greatest asset. With that in mind, we have designed a valuable, comprehensive benefits package to meet the needs of our employees and their families.

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