Insurance Verification Specialist in Canton, MI at APEX Systems

Date Posted: 8/16/2019

Job Snapshot

  • Employee Type:
  • Location:
    Canton, MI
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Job #:  989526
My name is La Vonna Willis and I help place candidates, such as yourself, in positions over all geographic regions for Apex Systems, Inc., the second largest staffing firm in the United States.

I currently have an Insurance Verification Specialist Position located in Canton MI If interested in hearing more about this opportunity, please respond with a copy of your updated word resume and the best time and phone number I can contact you on at

Job Title: Insurance Verification Specialist

Location: Canton MI 48188

Start Date: August 26th

Projected Contract length: Approximately 6 month contract to hire, chance for conversion based off performance/attendance. Apex cannot guarantee contract length.

Training: TBD

Hours: M-F 8 AM - 8 PM ; any 8 hour shift

Job Description:
  • 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.
  • 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. 

  • 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

EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, 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 844-463-6178-6178.