Insurance Verification Specialist - Las Vegas, NV

Insurance Verification Specialist                                                                     

Position Purpose:

To act as liaison between company, patients, Insurances, Pharma and Provider’s office to obtain and verify complete insurance information, coordinate benefits, help identify alternate funding for copay assistance when needed, and to manage the prior authorization process with the insurance prior to dispensing the prescription.

• Obtain and verify insurance eligibility for services provided and document complete information in system
• Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies
• Collect any clinical information such as lab values, diagnosis codes, etc.
• Determine patient’s financial responsibilities as stated by insurance
• Configure coordination of benefits information on every referral
• Ensure assignment of benefits are obtained and on file for Medicare claims
• Bill insurance companies for therapies provided
• Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures
• Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs
• Handle inbound calls from patients, physician offices, and/or insurance companies
• Resolve claim rejections for eligibility, coverage, and other issues

 

Organization Overview

Maxor provides patients and corporate clients across the country with pharmacy and healthcare services that are customizable, comprehensive and cost-effective. 

Founded in 1926, Maxor has grown from a single pharmacy in Amarillo, Texas, into a national leader in a number of areas, including retail and mail order pharmacies, pharmacy benefit management, pharmacy consulting and management, home infusion, specialty pharmacy, pharmacy audit, and pharmacy technology.

 The Maxor name originated from Howard Guy Maxfield and Samuel Orr who together founded Maxor Drugs. In 1966, Jerry H. Hodge, R.Ph. purchased the drug store, and under his leadership, the company continues to build on its legacy of innovation and service.       

 With corporate offices in Amarillo, Texas, the company also has regional offices in  California, Colorado, Florida, Georgia, Maryland, New York, Oklahoma, Texas, Vermont, Washington, Washington D.C., and West Virginia. 

 

Qualifications

  Education/Experience:

 

• High school diploma or equivalent.

• 1+ years of obtaining pharmacy benefit, insurance verification or medical billing experience.

• Experience with payors and prior authorization requirements.
• Strong written or verbal communication and customer service skills.

 

Ideal Candidate

• Analytical, self-motivated and detail  oriented
• Customer focused and critical thinker
• Ability to multi-task, problem solve, make decisions in fast-paced environment and work to deadlines 

 Logistics

• Full-time, non-exempt
• Position available in March 2018
• Position based in Las Vegas, NV
• Reports to the Pharmacy Manager

 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

EOE M/V/F/D