Medical Billing Specialist

Responsibilities

Analyze benefits inquiries for high-cost medications on insurance platforms.

Verify patient eligibility for medication coverage through insurance.

Initiate and manage the prior authorization process when necessary.

Communicate with healthcare providers and insurance companies to secure authorizations.

Verify claims eligibility and ensure accurate claims processing.

Investigate and resolve discrepancies or denials related to medication claims.

Estimate medication costs based on insurance coverage and benefits.

Provide cost information to patients and healthcare providers for informed decision-making.

Maintain accurate records and documentation for compliance and future reference.

Ensure compliance with healthcare regulations, policies, and procedures.

Demonstrate exceptional attention to detail to ensure accuracy in all tasks.

Qualifications and Requirements

Strong knowledge of pharmacy benefit plans, prior authorization processes, and claims eligibility.

Proficient in using insurance platforms and prior authorization system.

Meticulous attention to detail and the ability to manage complex information.

Clear and coherent in both written and verbal communication skills with the ability to communicate effectively with patients, providers, and insurance representatives.

Ability to work under pressure and handle multiple tasks simultaneously in a fast-paced environment.

Knowledge of HIPAA and compliance regulations.

Ability to work both independently and as part of a team.

Responsibilities

Analyze benefits inquiries for high-cost medications on insurance platforms.

Verify patient eligibility for medication coverage through insurance.

Initiate and manage the prior authorization process when necessary.

Communicate with healthcare providers and insurance companies to secure authorizations.

Verify claims eligibility and ensure accurate claims processing.

Investigate and resolve discrepancies or denials related to medication claims.

Estimate medication costs based on insurance coverage and benefits.

Provide cost information to patients and healthcare providers for informed decision-making.

Maintain accurate records and documentation for compliance and future reference.

Ensure compliance with healthcare regulations, policies, and procedures.

Demonstrate exceptional attention to detail to ensure accuracy in all tasks.

Qualifications and Requirements

Strong knowledge of pharmacy benefit plans, prior authorization processes, and claims eligibility.

Proficient in using insurance platforms and prior authorization system.

Meticulous attention to detail and the ability to manage complex information.

Clear and coherent in both written and verbal communication skills with the ability to communicate effectively with patients, providers, and insurance representatives.

Ability to work under pressure and handle multiple tasks simultaneously in a fast-paced environment.

Knowledge of HIPAA and compliance regulations.

Ability to work both independently and as part of a team.