Insurance Benefits Coordinator

1 week ago

Sydney, New South Wales, Australia beBeeBenefits Full time $80,000 - $110,000

This role plays a vital part in ensuring patients receive the specialty therapies they need by collaborating with healthcare providers and insurance payers to gather information about patient insurance coverage for specific pharmaceutical products.

Key Responsibilities
  • Support Healthcare Providers
  • Navigate Complex Reimbursement Issues
  • Process Prior Authorizations (PA) for assigned caseloads and appeals process to access medications

The successful candidate will be responsible for:

  • Conducting benefit investigations for patients by making outbound phone calls to payers to verify patient insurance benefit information, navigate complex reimbursement barriers, and seek resources to overcome these barriers
  • Verifying patient-specific benefits and documenting details including coverage, cost-share, and access/provider options
  • Identifying any coverage restrictions and details on how to expedite patient access
  • Documenting and initiating prior authorization processes and claims appeals
  • Reporting any reimbursement trends or delays in coverage to management

Requirements

  • In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage
  • 2-3 years of benefit investigation experience involving analysis and interpretation of insurance coverage
  • 2-3 years of experience interacting with healthcare providers regarding health insurance plan requirements
  • Excellent verbal communication skills and grammar

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