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Insurance Verification Analyst
TEKsystems. Provide subject matter expertise on medical and prescription insurance coverage, verification, claim billing, medication prior authorization, appeal filing, and alternate financial assistance opportunities .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical and prescription insurance coverage, including verification, claim billing, and prior authorization processes. Proficient in documenting information accurately and collaborating with healthcare providers and payors to ensure patient access to medications.
Highest-signal resume keywords
Medical Insurance KnowledgePrior Authorization ExpertiseClaim Billing ExperienceHealthcare Call Center ExperienceReimbursement Processes Understanding
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance VerificationAppeal FilingPharmacy OperationsBilling ProcessesPatient Demographic Entry
Soft Skills
Effective CommunicationCollaborationAttention to Detail
Tools & Technologies
Core Pharmacy SystemHub Information SystemWeb Tools for Benefits Investigation
Industry Keywords
HealthcareReimbursementPharmacyInsurance ProgramsAlternate Funding Resources
About the role
Key responsibilities & impact- Provide subject matter expertise on medical and prescription insurance coverage, verification, claim billing, medication prior authorization, appeal filing, and alternate financial assistance opportunities
- Accurately document information in appropriate systems and formats
- Communicate referral status to physicians and patients via phone, fax, and/or the core pharmacy system
- Assist offices through prior authorization and appeal documentation and filing
- Monitor authorization and appeal status to support rapid turnaround and patient access to medication
- Use internal and web tools to investigate pharmacy and medical benefits
- Collaborate with health insurance payors and providers and maintain payor intelligence resources
- Enter patient demographic and health insurance information into the hub information system
- Notify physicians of incomplete or incorrect insurance information
Requirements
What you’ll need- 1-3 years of work experience in a healthcare or reimbursement setting
- Previous experience in a call center environment, healthcare office, corporate setting, healthcare insurance provider, or pharmacy is required
- Thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs
- Knowledge of billing, alternate funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations
- Pharmacy call center experience preferred for A+ candidates
- Healthcare call center and medical claims experience preferred for A- candidates
Benefits
Comp & perks- Medical, dental & vision
- Critical Illness, Accident, and Hospital coverage
- 401(k) Retirement Plan with pre-tax and Roth post-tax contributions
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)