Title: Benefits Verification Specialist Location: Remote Duration: 3+ month’s Working hours: 8:30 am to 5:30 pm EST or 10:30 am – 7:30 pm EST Note: Training shift timing Schedule - 8:30 am – 5:30 pm EST or 10:30 am – 7:30 pm EST
Job Details:
Complete data entry from the enrollment form into the CRM.
Complete electronic eligibility checks for payer and coverage details.
Conduct a benefit investigation to determine plan coverage, payer restrictions, and cost share information from insurance plans.
Identify if coverage restrictions exist, the process in which they are handled.
Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results to the healthcare provider.
Position Summary: Under general supervision of an Operations Manager, the Benefits Verification Specialist will contact insurance companies to verify patient specific benefits for programs we administer. The Benefits Verification Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage.
Primary duties and responsibilities:
Reviews all patient insurance information needed to complete the benefit verification process.
Triages cases with missing information to appropriate program associate.
Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.
Identifies any restrictions and details on how to expedite patient access.
Could include documenting and initiating prior authorization process, claims appeals, etc.
Completes quality review of work as part of finalizing product.
Reports any reimbursement trends/delays to management.
Perform related duties and special projects as assigned.
Experience and Educational Requirements: High school diploma or GED required. Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate degree program, technical vocational training, or equivalent combination of experience and education. Two years (2) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement.
Minimum Skills, Knowledge and Ability Requirements:
Proficient Windows based experience including fundamentals of data entry/typing.
Working knowledge of Outlook, Word, and Excel.
Strong interpersonal skills and professionalism.
Independent problem solver, good decision maker, and robust analytical skills.
Strong attention to detail.
Effective written and verbal communication.
Familiarity with verification of insurance benefits preferred.
Attention to detail, flexibility, and the ability to adapt to changing work situations.
Strong customer service experience.
Work Environment: The work environment characteristics described here are representative of those an associate encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: The noise level in the work environment is consistent with an office setting.
Physical and Mental Requirements: The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
Visual requirement is for close vision, distance vision, peripheral vision and ability to adjust focus.
75% or more time is spent looking directly at a computer.
Ability to deal with stressful situations as they arise.
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $16.00/hr.
