Benefit Verification Auditor - Remote

Description

POSITION SUMMARY
This position will develop and perform complex audit reviews or special assignments to assess accuracies. Efficiently prepares and document with evidence the results of complex audit review, using correct formats, including source, purpose, conclusion, and results. Prepare audit reports to be signed off for next level audit review making sure to provide any needed feedback on incorrections surrounding benefit verification.

REQUIRED KNOWLEDGE, SKILLS & TRAINING

• Ability to read prescriptions.
• Knowledge of HCPC Codes (J-Codes).
• Experience with Major Medical Insurance.
• Ability to interpret medical policies.
• Knowledge of Pharmacy Benefit
• Familiar with medical documentation such as H&P’s, Genetic testing, Labs, etc.
• Knowledge of ICD-10 Codes (Diagnoses Codes).

ESSENTIAL JOB DUTIES

• Calling Insurance Plans to confirm information regarding benefits due to discrepancy with information.
• Validate benefit verification information against authorization approval information
• Review all benefit verification and Complex Audit forms for all complex drugs regarding new cases and new insurance
• Review EMR to ensure that the BV notes are reflecting accurately
• Referencing Smart Sheet / W Drive - Contracted / Not Contracted
• Communicate with BV Manager, PA Manager, and Auditing Team
• Updating Insurance to Fast Track system during BV Audit Review
• Sign off on audit from a benefit verification standpoint and submit via email for next level audit review
• POS (Place of Service) Confirming POS between PA, BV, and LOA if applicable and making sure Fast Track is updated accordingly.
• Utilizing Websites - CMS.Gov, State Medicaid to locate Drug Coverage / Codes if listed on Fee Schedules.
• Communicate with BV Team errors that has caused audit to be held up/denied
• Review of medical policies when needed - Locating Medical Policies through Insurance websites / Locating Employer Summary Benefit Plan / Handbooks if applicable
• Understanding Medical Benefits - Deductible /Out of Pocket - plan coverage before deduction / out-of-pocket met and plan / patient coverage after deductible / out of pocket met. Identifying if assistance is needed and Patient Enrolled.

EMPLOYEE BENEFITS

• BCBSL Medical
• EyeMed Vision
• Delta Dental
• PTO, Holiday Pay, and Floating Holidays
• Tuition Reimbursement
• 401k
• Accident & Critical Illness
• Life Insurance