Insurance Verification Specialist

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

*Able to work remote anywhere in the United States, Monday - Friday; 12:00 - 9:00 p.m. EST.*

Position Purpose: Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits.

• 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
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: High school diploma with 1+ years of medical billing or insurance verification experience. Bachelor’s degree in related field can substitute for experience. Experience with payors and prior authorization preferred.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act