Experienced Reimbursement Specialist - Customer Service Representative (Healthcare Benefits Verification)
Join blithequark's dynamic team as a Reimbursement Specialist, where you will play a vital role in ensuring seamless healthcare services for patients and healthcare providers alike.
About blithequark
At blithequark, we are committed to revolutionizing the healthcare industry by providing innovative solutions that prioritize patient care and satisfaction. Our team of dedicated professionals is passionate about delivering exceptional customer service and support, and we are now seeking an experienced Reimbursement Specialist to join our ranks.
Job Summary
As a Reimbursement Specialist, you will be responsible for verifying patient insurance benefits to ensure there are no lapses in coverage that could affect ongoing therapy. This involves checking current policy details and confirming that the patient's coverage remains active throughout their treatment period. You will work closely with healthcare providers to guarantee they receive appropriate reimbursement for their services, including verifying network status and reimbursement rates. Your expertise will ensure that all necessary prior authorizations are in place and valid, and that any required documentation is submitted correctly to avoid interruptions in treatment.
Key Responsibilities
* Place outbound calls approximately 35+ daily, with 20 cases or more closed per day
- Contact insurance providers to verify information and verify coverage changes
- Insurance Benefit Management: Collect and review patient insurance benefit information according to program SOPs; complete and submit insurance forms and prior authorizations in a timely manner, ensuring accuracy and adherence to third-party payer requirements
- Customer Service & Support: Assist physician office staff and patients with insurance forms and program applications; provide exceptional customer service to internal and external customers, resolving requests promptly and escalating complaints as needed
- Communication & Coordination: Maintain regular phone contact with provider representatives, third-party customer service reps, and pharmacy staff; effectively communicate with payors for benefit investigations and coordinate with inter-departmental associates as necessary
- Documentation & Reporting: Process insurance and patient correspondence; report reimbursement trends or delays to the supervisor; provide all necessary documentation for prior authorizations, including demographic details and relevant identification numbers
- Problem-Solving & Compliance: Analyze moderate scope problems within defined SOPs, exercising judgment to determine appropriate actions; report all adverse events in line with training and SOP; perform related duties as assigned with minimal instruction
Requirements
* 1 year of experience in specialty pharmacy, medical insurance, healthcare setting, and/or related experience
- Must be patient: Hold times may be up to 90 minutes by client requirements
- Must have a private, designated workspace
- Must be MS Office proficient: Excel, Outlook, Word
- Must be flexible on schedule and hours
- Employment verification required: Last 3 employers
- High school diploma or equivalent
- Background check required
Preferred Qualifications
* 2+ years of experience in healthcare benefits verification
- Experience with CRM systems and prior authorization processes
- Strong communication and problem-solving skills
- Ability to work in a fast-paced environment with multiple priorities
- Strong attention to detail and organizational skills
What We Offer
* Competitive hourly rate of $18.00 per hour, with a $1.00 per hour increase for 2+ years of experience in healthcare benefits verification
- Opportunity to work with a dynamic team in a fully remote environment
- Flexible scheduling with a minimum of 40 hours per week
- Comprehensive training program with a focus on customer service and benefits verification
- Opportunities for career growth and professional development
- A supportive and inclusive work environment
How to Apply
If you are a motivated and detail-oriented individual with a passion for customer service and healthcare benefits verification, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, through our online portal. We look forward to reviewing your application and discussing this opportunity further.
Note
* This is a contract, project role with a start date of December 1, 2024, and an end date of February 15, 2025.
- Training will take place from December 1, 2024, to December 31, 2024, and will consist of approximately 3 weeks of training, including practice and mock calls.
- A background check and employment verification will be required as part of the hiring process.
- A private, designated workspace is required for this role.
- Must be able to pick up and return equipment in Lake Mary, FL.
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