New 
Verification of Benefits Specialist
 Spectraforce Technologies | |
 United States, Texas, Plano | |
| 1201 West 15th Street (Show on map) | |
 Jun 27, 2025 | |
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Title - Verification of Benefits Specialist Location - Plano, TX, USA, 75024 Duration - 6 months Shift timing - 8 am - 5 pm Job Description: Responsibilities: * Assist with multiple levels of appeal in the event of initial coverage denial. * Forward authorized confirmation for procedure to designated patient provider. In addition, this position will provide in-servicing to new patient providers surrounding the pre-authorization process. * Responsible for managing multiple cases simultaneously within specific time frames * Follow all policies and procedures related to performing the job role adhering to all data use, storage and privacy policies as outlined by the client. * Verify benefits, complete authorization requests promptly * Timely follow up for requested authorizations * For each procedure, audit required clinical documents for completeness and accuracy * Obtain authorization for the facility, equipment and physician to perform various procedures from the insurance carrier * Work with key provider contacts to obtain required clinical information for authorizations * Work with respective carrier's utilization review department to obtain appropriate authorizations * Work within established guidelines when necessary to process appeal for denied requests * Train patients and their designated providers on pre-authorization processes and requirements, in person or by phone * Work individually and in a team environment to educate assigned Field Territory Managers and Clinical Specialists Education: Required HS diploma required, AA a plus Minimum of 2 plus yrs experience in a utilization (medical approval) environment or similar work experience Preferred * Knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. * Experience in medical device or DME Billing a plus * Proficient with Microsoft Office (Word & Excel specifically) * Medical billing software experience a plus * Knowledge of current CPT codes and familiarity with ICD-10CM (diagnosis coding) * Ability to accurately meet required time frames/deadlines * Ability to work as a team player and share workloads with other team members * Excellent verbal and written communication skills * Ability to train/present concepts to others | |