Job Title: Insurance Verification Specialist

Location: Fairfax Office, onsite

Reports to: Education Specialist

Schedule: as needed between 8am – 5pm, Monday – Friday

FLSA Status: Non-exempt

Job Summary:

The Insurance Verification Specialist is a proactive and detail-oriented professional who plays a key part in optimizing the prior authorization process, ensuring that patients receive access to the medications they need without unnecessary delays.

Essential Responsibilities:

• Insurance Verification: Accurately verify patients’ insurance coverage and benefits to confirm eligibility for prescribed medications and treatments.
• Formulary Review: Analyze formularies to identify covered medications and alternatives, ensuring compliance with insurance requirements.
• Clinical Information Gathering: Proactively collect and assess necessary clinical information from electronic medical records (EHR) to support authorization requests.
• Communication: Foster effective communication channels with patients, our providers, and other office staff to facilitate a smooth, efficient, authorization process and address any inquiries or concerns promptly.
• Process Improvement: Identify areas for enhancement in the prior authorization workflow and collaborate with team members to implement solutions that streamline operations and improve patient outcomes.
• Perform other related duties as assigned.

The responsibilities and the conditions for this position are subject to change due to business needs.

Required Skills/Abilities:

• Excellent organizational skills
• Strong interpersonal skills
• Proficiency in verification processes
• Knowledge of insurance benefits, coverage, and eligibility rules
• Attention to detail
• Takes initiative
• Excellence in problem-solving skills
• Ability to prioritize tasks
• Ability to function well in a high-paced and (at times) stressful environment

Education and Experience:

• High school diploma or equivalent
• Two or more years of experience as an Ophthalmic Technician (required)
• Experience with pharmacies or similar settings are highly desirable
• Experience with EHR software, such as NexTech is desirable

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times.