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Healthcare Specialist for Insurance Verification

2 weeks ago

Quezon City, National Capital Region, Philippines Sourcefit DR Full time

At Sourcefit DR, we are seeking a highly motivated and detail-oriented Healthcare Specialist for Insurance Verification to join our dynamic team. This role plays a critical part in our healthcare delivery processes, ensuring compliance with Federal and State regulations and policies regarding benefit verification and authorization.

The successful candidate will possess excellent communication skills, thorough knowledge of collection practices, and the ability to apply effective judgment in complex situations.

Key Responsibilities:

  • Gain and maintain a comprehensive understanding of patient insurance eligibility and benefits across a wide range of payers.
  • Demonstrate specific knowledge of Authorization processes related to GAPs, Pre-determinations, PCP Referrals, and Single Case Agreements.
  • Enter insurance and authorization information into EHR systems accurately and in detail, following Standard Operation Procedures.
  • Follow up on pending or expired authorizations and referrals as assigned.

Requirements:

  • A high school diploma or general education degree (GED) equivalent.
  • A minimum of 3-5 years of healthcare industry experience, with at least 3 years in intake/verification roles.
  • Home Infusion experience, or hospital or chemotherapy experience is required.
  • Proven experience in calculating drug units.