Insurance Verification Specialist in Pittsburgh, PA at APEX Systems

Date Posted: 5/11/2018

Job Snapshot

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Job Description

Job #:  848492


Insurance Verification Specialist


Job Summary:

  • 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.
  • 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.
  • Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s 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.
  • Incentives and perks for perfect attendance
  • Willing to work mandatory extra hours, this may include evenings, weekends and/or hours outside of normal business hours.

Minimum Experience:

  • High school diploma/GED.
  • At least 1 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 experience as an Insurance Verifier or similar position with Specialty Pharmacy.
  • At least 1 years of experience in obtaining prior authorizations.
  • At least 1 years of experience with the coordination of benefits, secondary insurance and/ or patient assistance programs.
  • At least 1 years of experience with concepts of plan design and comfortable with the processes of overrides and rejections.
  • 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.
  • 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).
  • Understanding the authorization process is a must









EEO Employer

Apex is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or 844-463-6178.