Insurance Verification Specialist (Conversions) AllianceRx Walgreens Prime 54 reviews - Frisco, TX Responsible for verifying patient eligibility, coordinating benefits, running test claims and determining patient coverage/responsibility for services including, but not limited to primarily major medical insurance benefits verification, complex insurance plan verification and high volume PBM plans. The IVS needs to understand and work with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical, and PBM. Understanding the authorization process is a must. The IVS will also be responsible for the coordination of benefits investigation and partnering with patient assistance programs. May also assist with testing and implementation of new planned business. Job Responsibilities * Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patients file. * Verifies patient insurance coverage of medications, administration supplies and related pharmacy services through proper investigation into either major medical benefits (including Medicare) or pharmacy benefits. * Facilitates and completes the prior authorization process with insurance companies and practitioner offices. * Completes a full Medical Verification for all medications, administration supplies and related pharmacy services. * Notifies patients, physicians, practitioners and/or clinics of any financial responsibility of services provided and requested services that are not provided by the facility. * Facilitates pharmacy and/or major medical claims with insurance companies and practitioner offices and investigates and facilitates prior authorization and any other claim rejections. * Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or delivery is necessary. Places outbound calls to patients or physicians offices to obtain additional information needed to process the script or to notify of delay in processing script. * Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners and clinics regarding inquiries about services provided, financial responsibility and insurance coverage. Required qualifications, skills and experience Basic Qualifications: * High school diploma/GED. * At least 2 years of insurance verification and/or pharmacy tech experience in using J-codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B&D billing, Major Medical, PBM, authorization; OR at least 1 year of experience with AllianceRx Walgreens Prime; OR at least 6 months experience as an Insurance Verifier with WSP. * At least 2 years of experience in obtaining prior authorizations. * At least 2 years of experience with the coordination of benefits, secondary insurance and/ or patient assistance programs. * At least 2 years of experience with concepts of plan design and comfortable with the processes of overrides and rejections. * Knowledge of and ability to explain concepts of medical benefit plan design (cost benefit, co-insurance, lifetime benefit, out-of-pocket maximum, using J-codes, CPT codes and Diagnosis codes/ route of admin /place of service). * At least 1 year experience in providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction. * Problem solving experience. * Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction. * Willing to work mandatory extra hours, this may include evenings, weekends and/or hours outside of normal business hours. * Basic level PC skills (for example: start up and shut down computer, use mouse to point and click, start and close programs, switch between programs, save files, print documents, access information on-line, etc.). * Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures and dates, using find and replace, undo, spell check, track changes, review pane and/or print functions). * Basic level skill in Microsoft Excel (for example: opening a workbook, inserting a row, selecting font style and size, formatting cells as currency, using copy, paste and save functions, aligning text, selecting cells, renaming a worksheet, inserting a column, selecting a chart style, inserting a worksheet, setting margins, selecting page orientation, using spell check and/or printing worksheets). * Basic Internet Explorer skills experience to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online. * Keyboarding skills basic level (for example: operate by touch the letter, number, and symbol keys with minimal errors). Desired qualifications, skills and experience Preferred Qualifications & Interests (PQIs) * Pharmacy Technician License or Certification preferred unless required by state as granted by the state Board of Pharmacy or nationally recognized certification agency. * At least 3 years experience in obtaining prior authorizations, pharmacy benefit or medical billing experience. * At least 1 year experience in a call center. * Basic skill level in Microsoft PowerPoint (for example: inserting, rearranging, hiding and deleting slides, navigating between slides, increasing list level, adding, centering and editing text, changing views, inserting a table or a note, moving objects, printing outline view and/or running a slide show). * Experience in calculating benefit usage balances, co-pays, days of supply, and other health insurance mathematical calculations. 8 hours ago - save job - original job Apply On Company Site Other jobs you may like Insurance Verification Specialist A-Line Staffing Frisco, TX 1 day ago Easily apply Insurance Verification Specialist A-Line Staffing The Colony, TX 8 days ago Easily apply Benefit Verification - Insurance Verification Aline Frisco, TX 6 days ago Easily apply Manager, Insurance Verification AmerisourceBergen Frisco, TX AmeriSourceBergen - 28 days ago Medical Insurance Verification Specialist AmerisourceBergen Frisco, TX AmeriSourceBergen - 30+ days ago * Insurance Verification Specialist jobs in Frisco, TX * Jobs at AllianceRx Walgreens Prime in Frisco, TX * Insurance Verification Specialist salaries in Frisco, TX AllianceRx Walgreens Prime 54 reviews Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume