Nira Medical Group
Benefits and Authorizations Specialist Lead
Nira Medical Group, Kansas City, Missouri, United States, 64101
Job Summary
The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.
Key Responsibilities
Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
Obtain insurance authorization and pre-certification for office visits and infusion services.
Facilitate insurance denial mitigation steps such as peer‑to‑peer reviews and appeals.
Maintain a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
Calculate and communicate patient financial responsibility.
Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications
High school diploma or equivalent
2‑3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
Knowledge of insurance terminology, plan types, structures, and approval types
Previous experience with J‑codes, CPT and ICD‑10 coding
Previous Athena use is a plus, but not a requirement
Knowledge of medical terminology and clinical documentation review
Strong organizational skills
Detail‑oriented
Ability to multi‑task and work well in a fast‑paced setting
Critical thinking skills and decisive judgment
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Key Responsibilities
Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
Obtain insurance authorization and pre-certification for office visits and infusion services.
Facilitate insurance denial mitigation steps such as peer‑to‑peer reviews and appeals.
Maintain a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
Calculate and communicate patient financial responsibility.
Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.
Qualifications
High school diploma or equivalent
2‑3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.
Knowledge of insurance terminology, plan types, structures, and approval types
Previous experience with J‑codes, CPT and ICD‑10 coding
Previous Athena use is a plus, but not a requirement
Knowledge of medical terminology and clinical documentation review
Strong organizational skills
Detail‑oriented
Ability to multi‑task and work well in a fast‑paced setting
Critical thinking skills and decisive judgment
#J-18808-Ljbffr