[Hiring] Biologics and Medications Insurance Specialist @National Jewish Health

Role Description

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

• 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.
• Verification includes obtaining and documenting covered and non-covered benefits, plan type, co-payment, co-insurance, out of pocket, and deductible amounts.
• Determines contract and benefit eligibility.
• Notifies 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.
• Conducts clinical screening and provides 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 administering medications.
• Coordinates retroactive authorizations with medical staff, ancillary departments and insurance plans as necessary.

Qualifications

• High School Diploma or equivalent required.
• Associate’s degree preferred.
• A minimum of 3 years of experience within a healthcare environment required.
• Experience as an LPN, Medical Assistant, or Pharmacy Technician preferred.

Requirements

• Accepts full responsibility for self and contribution as a team member.
• Displays honesty and truthfulness; confronts problems quickly.
• Displays a strong commitment to organizational success.
• Accomplishing tasks by considering all areas involved, no matter how small.
• Cooperates with others to accomplish common goals.
• Ensures that the customer perspective is a driving force behind business decisions.
• Effectively manages one’s time and resources to ensure that work is completed efficiently.
• Interacts with others in a constructive, positive, and respectful manner.

Benefits

• Comprehensive Medical Coverage: Multiple Cigna health plans for Colorado, regional office and remote employees.
• Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) available to pair with some plans.
• Generous PTO accruals to use for vacation and sick days, and six paid holidays.
• Dental & Vision Plans: Coverage effective the first of the month after hire.
• 403(b) plan with employer contributions after two years.
• Earn up to $200 annually for preventive health activities.
• Tuition Reimbursement: Up to $5,250 annually for full-time and part-time employees.
• Childcare Flex Spending Account (FSA) with annual employer contribution.
• Public Service Loan Forgiveness (PSLF) eligible employer.
• Employer-paid plans and optional buy-up choices for Disability & Life Insurance.
• Full suite of coverage options such as Accident, Hospital Indemnity and Legal Plan.
• Savings on local services, insurance, and RTD bus passes.