Insurance Verification Representative - CGM

Position Description

Support verification process by assisting with team collaboration and contributing to efficient insurance verification workflows.
Work to secure in- and out-of-network referrals through ongoing communication with health plans, providers, and patients.
Help ensure comprehensive support by exploring coverage options, obtaining required documentation, and maintaining accurate records, with a primary focus on Continuous Glucose Monitors (CGM) supplies.

Essential Responsibilities and Duties

• Continuously expands expertise in Medicare, Medicaid, and commercial payers, with a focus on Continuous Glucose Monitors (CGM) supplies, to maximize opportunities for servicing both in- and out-of-network patient referrals, including securing gap exceptions or standard prior authorizations and PCP referrals, LOA, TPAs, and cash pay solutions.
• Support the tracking and maintenance of team KPIs, assisting with reporting and ongoing review of benchmarks related to sales, verification workflows, and health plan benefit administration. Help identify performance trends and contribute to problem-solving efforts, with a primary focus on CGM and Maternity lines of business.
• Aid in managing workflow processes and project timelines by coordinating tasks, supporting resource needs, and helping ensure deliverables are completed on time. Collaborate with cross-functional teams to support organizational goals and objectives.
• Assist in the development and maintenance of private insurance contact cards, ensuring high utilization across Billing, Client Operations, Quality Assurance, and Payer Relations teams.
• Participate in the Certified Training Assistant (CTA) program as a CTA, and successfully complete available leadership development programs to actively mentor PRISM team members company-wide about private insurance and support Training & Development.
• Support departmental goals by assisting with referral, verification, and authorization and follow-up processes. Monitor and process orders accurately, coordinate with referral and insurance partners as needed, and help maintain positive relationships across the organization.
• Assist with administrative responsibilities and maintaining required patient documentation. Support supervisors as needed to help ensure smooth daily operations and complete patient files.
• Participate in in-services, education, and training to address and resolve knowledge gaps and issues regarding health plan protocols, procedures, processes, and overall effectiveness of referral sources.
• Maintain an excellent attendance record and drive strong attendance among department team members through accountability measures and incentives.
• Adhere to all company policies and procedures regarding employment, safety, and compliance, and report any concerns of non-compliance to management immediately.

Qualifications

High school diploma or equivalent.
Experience in healthcare, insurance verification, or a related field preferred.
Strong communication and interpersonal skills.
Ability to work independently and as part of a team.
Proficiency in Microsoft Office Suite.

Benefits

We offer a comprehensive benefits package including:

• 401(k) matching
• Tuition assistance
• Company-paid holidays
• Employee engagement events

Pay

$XX.XX per hour

Schedule

Full-time, Monday through Friday, 8:00 AM – 5:00 PM