Insurance Verifier in Canton, MI at APEX Systems

Date Posted: 3/8/2018

Job Snapshot

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

Job Description

Job #:  820768

Insurance Verifier Opportunity in Canton, MI!

Contract: initial 6 month contract with possibility of perm

Location: Canton, MI 48188

Job Summary 
Responsible for performing the appropriate procedures to verify patient eligibility, coordinate benefits, run test claims and determine patient coverage/responsibility for services and testing and implementation of new plan business. 

Job Responsibilities 
-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. 
-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 any other insurance 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 physician’s 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. 

High school diploma/GED. 


-At least 1 year insurance verification and/or pharmacy technician experience OR at least 6 months specialty pharmacy 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 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 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 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. 

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 1 year experience in obtaining prior authorizations, pharmacy benefit or medical billing experience. 
-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 a healthcare or pharmacy setting. 
-At least 1 year experience in a call center. 
-Experience in calculating benefit usage balances, co-pays, days of supply, and other health insurance mathematical calculations.