Insurance Verification Representative Elikn, NC Monday - Friday 8a-5p EST In - Office

Position Description:

Support verification process by assisting with team collaboration and contributing to efficient insurance verification workflows. Work to secure in- and out-of-network referrals through ongoing communication with health plans, providers, and patients. Help ensure comprehensive support by exploring coverage options, obtaining required documentation, and maintaining accurate records, with a primary focus on Continuous Glucose Monitors (CGMs).

Essential Responsibilities and Duties:

1. Continuously expands expertise in Medicare, Medicaid, and commercial payers, with a focus on Continuous Glucose Monitors (CGM) supplies, to maximize opportunities for servicing both in- and out-of-network patient referrals, including securing gap exceptions or standard prior authorizations and PCP referrals, LOA, TPAs, and cash pay solutions.

2. Support the tracking and maintenance of team KPIs, assisting with reporting and ongoing review of benchmarks related to sales, verification workflows, and health plan benefit administration. Help identify performance trends and contribute to problem-solving efforts, with a primary focus on CGM and Maternity lines of business.

3. Assist in managing workflow processes and project timelines by coordinating tasks, supporting resource needs, and helping ensure deliverables are completed on time. Collaborate with cross-functional teams to support organizational goals and objectives.

4. Actively contributes to the development and maintenance of private insurance contact cards, ensuring high utilization across Billing, Client Operations, Quality Assurance, and Payer Relations teams.

5. Participates in the Certified Training Assistant (CTA) program as a CTA, and successfully completes available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development.

6. Support departmental goals by assisting with referral, verification, and authorization and follow-up processes. Monitor and process orders accurately, coordinate with referral and insurance partners as needed, and help maintain positive relationships across the organization.

7. Ensure accurate and timely attention to workflow processes within the CGM division, including tracking and completing all tasks across different workflows. Assist with administrative responsibilities and maintaining required patient documentation. Support supervisors as needed to help ensure smooth daily operations and complete patient files.

8. Participates in in-services, education, and training to address and resolve knowledge gaps and issues regarding health plan protocols, procedures, processes, and overall effectiveness of referral sources.

10. Maintains an excellent attendance record and drives strong attendance among department team members through accountability measures and incentives.

11. Adheres to all company policies and procedures regarding employment, safety, and compliance, and reports any concerns of non-compliance to management immediately.

12. Performs other related duties as requested and assigned by Leadership.

Education/Experience/Knowledge Requirements:

• High School Diploma or equivalent, Associates or Bachelor's degree and 3 years of experience in a management/supervisory position, preferred OR any similar combination of education and experience.
• 2 years of healthcare experience in a medical office setting, preferred.
• A deep understanding of HME rules and regulations, preferred.
• Ability to develop and utilize cross-functional relationships to facilitate the accomplishment of work goals and objectives.
• Effective verbal and written communication skills.
• Strong attention to detail in composing, typing, and proofing materials, establishing priorities, and meeting deadlines.
• Ability to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
• Ability to professionally interact and communicate with individuals at all levels of the organization.

Physical Requirements:

• In an 8 hour day the employee lifts/carries 10 LBS rarely.
• In an 8 hour day the employee stands 1 hour.
• In an 8 hour day the employee sits 7 hours.
• In an 8 hour day the employee drives a vehicle 0 hours. Vehicle operation is rare, less than monthly.

Travel Requirements:

Percentage of travel expected to be 5% or less on an annual basis

PRISM provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

This position is currently accepting applications.

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