We’re seeking a self-directed professional with:

• Working knowledge in the insurance verification process and third party verification terminology
• Ability to scrutinize insurance data independently and evaluate information for clarity, accuracy, and completeness
• Knowledge in the functional operations of third party payers and utilization review agencies to expeditiously coordinate follow-up
• Knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, CCS programs, out of state Medicaid, or other sponsoring agencies
• Knowledge of health plans with special processing requirements for emergency patients and ability to effectively communicate these requirements to physicians and administrative personnel under time-urgent conditions
• Knowledge of healthcare insurance and medication prior authorization and basic working knowledge coding
• Knowledge of authorization submission and reimbursement for high-cost specialty services and medication administration
• Knowledge of ICD-10, CPT-4, and HCPCS codes as applied to the authorization submission and claims reimbursement
• Knowledge of medical terminology
• Proficient in basic math
• Proficient in Microsoft Office Suite, specifically Excel, Word, and Outlook
• Availability to work rotating weekends and holiday coverage

Note: May subject to test qualifying skills