The Benefit Investigation (BI) Specialist is responsible for ensuring adherence to processing policies and procedures, researching payer coverage criteria, and tracking processing trends to improve accuracy and timeliness. This role is dedicated to protecting confidential patient health information (PHI) will be paramount as you review and validate processing accuracy completed by our specialists.
The BI Quality Specialist is a part of the Benefit Investigation Department in the Arlington, Virginia, office and reports directly to the Insurance Verification Supervisor.
- Protect confidential patient health information (PHI) at all stages of the verification of quality review process.
- Review entire processing accuracy completion by the insurance verification specialist to ensure processing policy and procedure accuracy for patients seeking treatment with Kerecis products.
- Review insurance specialist processing of researching payer coverage criteria and required prior authorization requirements are followed.
- Tracks and identifies processing trends to identify accuracy of insurance benefit verification results to the healthcare provider and completion in a timely manner.
- Evaluate the insurance verification process to identify more efficient automated processing.
- Assist with identifying any payer delays/challenges and/or escalated complaints.
- Collaborate with BI Manager on identifying team training, processing trends and processing updates.
- Develop productive working relationships with the U.S. Direct Sales team Market Access and Reimbursement teams to coordinate support to healthcare providers and patients.
- An analytical mind with strong attention to detail
- Highly organized and detail-oriented with a passion for ensuring projects proceed
- Ability and desire to work collaboratively and independently to ensure successful operations
- Working knowledge of necessary industry-related tools
- Strong interpersonal skills and extremely resourceful
- Strong insurance knowledge, ideally within the medical industry
Education & Experience
- Bachelor’s degree required in a relevant field, or relevant work experience
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time. Kerecis LLC is an equal opportunity employer.