Insurance Verification Analyst

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

Under minimal supervision, this position supports the Specialty, Infusion, and Enteral Insurance Verification and Authorization Teams by reviewing escalations from the Revenue Cycle Team. The role is responsible for tracking and trending errors, conducting root cause analysis, and identifying opportunities for process improvement. Additional responsibilities include maintaining reference materials, coordinating single patient agreements, generating price quotes, managing team audits, preparing reports, and providing team education as needed.

Responsibilities

• ·Expert knowledge in insurance verification, payor guidelines, contract pricing, test claims and authorizations

• Act as the primary point of contact between the Intake team and Revenue Cycle Management.

• Coordinate meetings or case reviews to align both teams on action plans and account resolution.

• Identify trends and systemic issues contributing to errors

• Identifies areas of focus to improve team efficiencies and works with Supervisor to implement necessary changes.

• Recommend and implement solutions to prevent future escalations.

• Work with intake staff to ensure accurate and complete insurance documentation.

• Provide feedback on intake and verification workflows that impact reimbursement.

• Collaborate on updates to policies and procedures to improve claim outcomes.

• Generate reports summarizing issues, resolutions, and recommendations for leadership.

• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks.

• Demonstrates ability to communicate effectively and express ideas clearly.

• Performs in accordance with system-wide competencies/behaviors.

• Performs other duties as assigned.

Skills & Abilities

• Exceptional written and verbal communication skills, with a strong focus on customer service.

• Self-starter with the ability to work independently and manage time effectively.

• Strong interpersonal skills with the ability to build rapport and maintain professionalism.

• Detail-oriented with excellent organizational and problem-solving abilities.

• Adaptable and able to remain effective in a dynamic, fast-paced environment.

• Skilled in conflict resolution and handling sensitive interactions with discretion.

Requirements

• HS diploma or GED required.

• 1+ years of pharmacy claims, pharmacy tech, and/or other related experience in a physician practice, ancillary provider, or other relevant healthcare preferred.

• Knowledge of medical terminology, coordination of benefits

• Knowledge of payer websites preferred.

• Knowledge of medical terminology required.

• Knowledge of pharmacy payers and authorization requirements preferred

• Proficient computer skills and Microsoft Office Products required.

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.