Case Administrator I

The purpose of this position is to process applications, introduce the assistance program, conduct benefits investigation for patients, address questions regarding coding and billing guidelines, and navigate complex reimbursement issues. This includes initial entry of patient data into the system, looking up insurance benefits, contacting insurers, advising the healthcare provider and/or patient of patients’ benefits, and identifying patient access barriers and seeking resources to overcome barriers.

Responsibilities:

• Answer inbound calls and make outbound calls to introduce services, gather patient data, address the needs of the patient and review insurance benefits. Record the call details in patient data system.

• Contact insurers for verification of benefits, coordinate prior authorizations and appeals with healthcare provider, and create reference guide.

• Collaborate with field team to maximize access to products and minimize associated administrative barriers.

• Handle difficult patient situations when they arise.

Education required: High School Diploma

Specific type of experience required:

• 5 to 10 years’ of benefit investigation involving the analysis and interpretation of insurance coverage

• 3 to 5 years’ of experience interacting with healthcare providers in regards to health insurance plan requirements

Education preferred:

• Associates or Bachelor Degree in Science, Finance, or Business

Specific type of experience preferred:

• Supervisory or Lead experience with a benefits group

• 10 or more years of patient benefit coordination

• Siebel system experience

• Has an in-depth understanding of Medicaid and Commercial plans

Qualifications

Education required: High School Diploma

Specific type of experience required:

• 5 to 10 years’ of benefit investigation involving the analysis and interpretation of insurance coverage

• 3 to 5 years’ of experience interacting with healthcare providers in regards to health insurance plan requirements

Additional Information

Thanks and regards,

Sneha Shrivastava

862 579 4236