Insurance Verification Specialist

As a Managed Care Specialist (MCS) at Dexcom, you play a critical role as you interact with patients, parents/caretakers, insurance carriers and healthcare professionals to verify insurance coverage for Dexcom's product offerings, including benefits, eligibility and coverage levels. As a key member of the Customer Operations team, you take pride in submitting prior authorization requests to insurance company as well as following up on all outstanding authorization requests until an outcome is determined. You are a strong partner with several internal and external team members as you act as a liaison between insurance companies, Regional Account Directors, Customer Operations Personnel, outside sales, and Patient Billing teams. You ensure a high quality experience for each patient by appropriately engaging and connecting with them. Each day offers new and exciting challenges to tackle including:
Perform administrative functions such as answering incoming calls, placing calls, documenting correspondence, etc.
Actively participate in creating a sales team environment and in meeting and exceeding sales objectives.
Process opportunities staged and statused under Managed Care responsibilities within OSR Expectations, such as verifying benefits, requesting authorization, & following up on auth-requests.
Ensure all insurance benefit information is captured in our database including risk entity, estimated Out Of Pocket expenses, deductible met, authorization start & end dates, etc.
Prepare correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement
Document all correspondence in the company databases.
Troubleshoot and problem solve issues over health insurance coverage and explanation of benefits, orders and sales efforts.
Become a well-versed in Continuous Glucose Monitoring System (CGMS) insurance benefits coverage to payers, discuss how it works, and describe the functions and supplies that go with CGMS.
Suggest revisions to Insurance Decision Trees to improve benefit access efficiency & DSO.
Coordinate efforts to increase access to & awareness of CGM with Insurance Companies.
Review payer document requirements and provide the Regional Account Directors with data to support broader access to CGM therapy.
May help to create, provide or request forms to collect clinical data on patients.
This position assumes and performs other duties as assigned.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
High school diploma/GED required.
Typically requires a minimum of 1+ years of insurance verification, medical customer service or other related experience.
Keen ability to multitask and think on your feet without missing a beat!
Strong written and oral communication skills including strong phone acumen to effectively communicate across diverse populations including patients, parents/caretakers and healthcare professionals.
Ability to become a Subject Matter Expert on Dexcom products, diabetes and Dexcom's competitive advantage over our competitors' products.
Strong proficiency in using a computer and computer applications including creating/editing Word documents and/or Excel spreadsheets, conducting researching using the internet, using templates, working in a company-created database and using Outlook (email/calendar functions).
Must understand the intricacies of medical and pharmacy insurance coverage as it pertains to Durable Medical Equipment (DME).
Must know and understand the difference between HMO, PPO, EPO, Indemnity, POS, Home Plans and Host Plans and be able to clearly communicate that to a patient and or other caregiver or medical professional.
Ability to learn and retain the specific criteria and requirements for different insurance plans
Outstanding Organizational & Time Management Skills:
Handle multiple tasks and organize multiple files simultaneously.
Work with Insurance Verifier to assure that follow ups completed timely and offer assistance as needed.
Think in an anticipatory way - be one step ahead of the process.
Know how to prioritize patient files on a daily and monthly basis.
Manage your time based on time of month, knowing when getting new patients is priority, when getting documentation is priority and shipping CGM's is priority.
Outgoing, Confident, and Self-Motivated:
Pleasant personality to work in a high stress, fast-paced environment.
Be able to make solid decisions and take the initiative.
Strong communication skills for being on the phone constantly with patients, parents, physicians, physician offices, and DexCom affiliates.
Flexibility to learn and change along with an evolving department is key.
Ability to be creative with ideas to improve sales and processes.
Work independently but also function well as part of the team to meet shared goals.
Preferred Qualifications
Bachelor's degree
Knowledge of diabetes
About Dexcom: Founded in 1999, Dexcom, Inc. provides continuous glucose monitoring technology to help patients and their clinicians better manage diabetes. Since our inception, we have focused on better outcomes for patients, caregivers, and clinicians by delivering solutions for people with diabetes ‚€” while empowering our community to take control of diabetes.
Are you ready to take your career to a place where your work truly makes a difference in the lives of others? Using your expertise while improving lives, sounds like a win-win to us. Do you have the drive and desire to be a difference maker? If so, we would love to hear from you‚€
Equal Opportunity Employer Minorities/Women/Veterans/Disabled

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