Tennessee Orthopaedic Alliance

  • Benefit Verification Specialist - High Dollar Drug

    Job Locations US-TN-Clarksville | US-TN-Nashville
    Posted Date 2 weeks ago(7/5/2018 11:02 AM)
    Job ID
    # of Openings
  • Overview

    TOA is seeking a Benefit Verification Specialist to focus on our High Dollar Drug (HDRx) programs in a centralized effort. All of our Benefit Verification Specialists are responsible for the timely verification of medical insurance benefits for our patients, ensuring that they are able receive the treatment as intended. With the emerging importance of HDRx, TOA is seeking someone who can understand the nuances of Benefits Verification for the TOA enterprise. This person will report directly to the Director of Durable Medical Equipment, but will have a close working relationship with our various site managers and our Central Business Office.


    The Benefits Verification Specialist focusing on HDrx will perform the primary responsibilities of a Benefits Verification Specialist. They will:

    • Utilize TOA systems for insurance verification and determining insurance compatibility with TOA’s managed care plans
    • Work to acquire and verify information by placing phone calls or communicating with patients, patient’s representatives, insurance companies, and facility personnel
    • Trouble shoot and resolve any issues with coverage, referrals, pre-certification and escalate complicated issues to the immediate manager
    • Ensure information in the insurance fields is correct to its entirety.


         Special HDRx Responsibilities

    • Become an expert in the field of HDRx – visco supplemental benefit verification, effectively reducing/eliminating pre-certification errors
    • Develop a sense of ownership and accountability for HDRx benefits verification across TOA, establishing effective processes to enhance verification and collections
    • Schedule treatments/injections at TOA clinics, as well as provide collection activities for services provided


    The Benefits Verification Specialist for HDRx will need the following experience and qualification requirements:

    • At least two years of insurance verification experience, with much of that dealing with HDRx or similarly complex healthcare services
    • Exceptional ability to gather information from payers in order to understand the shifting landscape of HDRx and apply those criteria to the TOA HDRx delivery protocol
    • Demonstrated experience is a self-starter, able to work across geographic or organizational boundaries to achieve high performance
    • A high energy level, focusing on completion of our HDRx volume – currently at about 15 patients per day
    • Attention to detail is a must, as this position requires the ability to obtain specific information, follow directions, organize and prioritize day-to-day tasks in order to keep work flow current
    • College degree with emphasis in healthcare administration preferred, and high school diploma required


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