Shire Jobs

Job Description:

The Insurance Benefit Coordinator functions as an integral member of a multidisciplinary intake team which manages the care of new patients. This position will verify a patient's health benefits and coverage for infusion services. The Insurance Benefit Coordinator works closely with the Intake team to process new referrals timely. Ensures accurate and complete verification of insurance benefits. Works closely with clinical staff and Intake team in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with maintaining high service standards.

Essential Duties and Responsibilities:

• Provides timely acceptance and completion of new referrals.

• Performs in-depth benefit verification.

• Reviews insurance medical policy requirements and FDA guidelines.

• Obtains all needed information from the MD office for insurance authorizations.

• Submits requests for insurance authorization, following up on denials, peer-to-peer reviews, and appeals.

• Answers calls from queue and assists callers in a timely and polite manner.

• Gives high priority to client satisfaction and anticipates customer needs.

• Provides excellent internal and external customer service by ensuring work meets quality standards; sets high goals or standards of performance for self; takes pride in his/her work and completes work on schedule.

• Demonstrates adaptability to an increasingly complex and changing environment; maintaining composure under pressure.

• Takes initiative to present ideas and suggestions for process improvements to the team lead, supervisors, and management.

• Maintains industry knowledge regarding insurance authorization requirements, limitations, and exceptions.

• Performs other duties and projects as assigned.

Required Behavioral Competencies:

• Adaptability

• Communication

• Dependability

• Detail Oriented

• Patient/Customer Focus

• Planning and Organizing

• Positive Impact

• Teamwork

Job Requirements:

• Bachelor's Degree of any related course preferred

• Proficient in Microsoft Office Suite, EMR software

• Strong background in Insurance Verification.

• Background in Insurance Authorization.

• Ability to interpret medical results.

• Familiar with the medical procedure codes.

• Understands the difference between medical and pharmacy benefits.

• Atleast 2 years working experience handling Insurance benefits.

• Must uphold all principles of confidentiality and patient care to the fullest extent while adhering to and complying with the Health Insurance Portability and Accountability Act (HIPAA) at all times.

• Experience handling US Client/Customer is a plus.

• Knowledge of, and sensitivity to, cultural and language differences.

• Able to perform basic mathematical computations.

• Amenable to work ONSITE.

• Willing to work following the US Timezone.

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