About the role

Aplyr's Quick Take

This role is primarily about managing the insurance verification and authorization process for patients receiving medical and infusion services. You'll be responsible for ensuring patients get the coverage they need, handling appeals for denied claims, and providing financial assistance support. It's an individual contributor role focused on detailed administrative tasks.

Good fit

This position is ideal for someone with 2-3 years of experience in medical insurance verification and prior authorizations, particularly in infusion services. A detail-oriented person who can handle multiple tasks in a fast-paced environment will thrive here.

Worth noting

The role requires a solid understanding of insurance terminology and coding, which may be a barrier for some applicants. There's also an emphasis on critical thinking and problem-solving, especially when dealing with denied claims.

Job Summary: The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.

Key Responsibilities:

Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
Obtains insurance authorization and pre-certification for office visits and infusion services.
Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
Calculate and communicate patient financial responsibility.
Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

Qualifications:

High school diploma or equivalent
2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
· Knowledge of insurance terminology, plan types, structures, and approval types
· Previous experience with J-codes, CPT and ICD-10 coding
Previous Athena use a plus, but not a requirement
· Knowledge of medical terminology and clinical documentation review
Strong organizational skills
Detail-oriented
Ability to multi-task and work well in a fast-paced setting
Critical thinking skills and decisive judgment

Skills & Tags

go ai

Aplyr's read

Nira Medical is at the forefront of healthcare technology, specializing in pain and chronic disease management, attracting professionals dedicated to innovative patient care.
Synthesized from recent postings & public sources

What's promising

•Nira Medical focuses on cutting-edge solutions for pain and chronic disease management.
•The company offers diverse roles, emphasizing flexibility, such as four-day work weeks for some positions.
•Nira Medical's outpatient focus provides employees with a predictable work-life balance.

What to watch

•Limited public information about the company's financial performance and stability.
•The niche focus on pain and chronic disease management may limit broader career opportunities.
•Potential geographic constraints with roles concentrated in specific regions like Florida and Texas.

Why Nira Medical

•Specializes in outpatient neurology roles with no on-call requirements.
•Emphasizes innovative approaches in pain management technology.
•Offers hybrid roles, blending remote and in-clinic work, catering to modern work preferences.

Aplyr’s read is generated by AI from public sources. Was it useful?