Insurance Authorization Specialist

Full Job Description

We are seeking an experienced, authorization specialist to verify insurance eligibility and verify authorizations prior to services being rendered. The successful candidate will be responsible for coordinating the flow of information between the clinical team and the billing office to ensure services are covered. If you are an independent thinker who enjoys being busy and understands that teamwork and great patient care is our mission, we would welcome the chance to explore this opportunity with you.

This is an outstanding chance to become part of a great team in a healthcare facility

PRIMARY RESPONSIBILITIES

• Verifies health insurance eligibility and obtains benefit information for the patient’s insurance policy.
• Reviews clinical documentation to ensure it supports the insurance requirements for the service to be approved.
• Requests pre-authorization for procedures within 24 hours of receiving notification of the service requested.
• Accurately and in a timely manner updates the patient’s medical record with actions taken on the request for authorization.
• Works with clinical staff when additional information is required to secure an authorization.
• Follows up on pending authorization requests in a timely manner.
• Submits requests and appeals for denied authorizations. Works with the clinical staff to ensure appeals are accurate and complete, involving the provider when necessary.
• Acts as a liaison between patients, the providers and the health insurance to assist patients in understanding their financial responsibilities.
• Answers calls from providers, patients and insurance companies related to authorization requests.
• Stays current with insurance changes and communicates any new changes to Supervisor/Manager in a timely manner.
• Works with front desk and scheduling staff to ensure that correct billing information has been collected during the scheduling and/or check-in process.
• Attends meetings, as assigned, and participates in educational activities to keep skills up to date.
• Maintains open communication with clinical staff to minimize interruptions to the providers’ schedules.
• Performs other duties necessary to maintain the overall efficiency and continuity of the clinic.
• Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues.

Work environment

1. Daily operation of various office equipment: fax machine, telephone & voice mail operating system, stationary/laptop computer, e-mail system, copier.

2. Required to sit or stand for extended periods of time.

3. Ability to maintain confidentiality in the performance of duties.

4. Ability to complete work in a timely, accurate and thorough manner.

5. Ability to work collaboratively with members of the Physician practices.

qualifications

• High school graduate or high school equivalency credential.
• Minimum 1 year experience in medical billing or related revenue cycle process.
• Experience utilizing insurance web products preferred.
• Knowledge of CPT and ICD10, health insurance billing and claim processing required.
• Excellent communication and interpersonal skills, with the ability to interact with all internal and external customers in a professional and caring manner.
• Ability to make well-reasoned decisions, both independently and as part of a team.
• Proficient computer skills including Microsoft Office and email.
• Maintains patient confidentiality per state and federal and company regulations.
• Excellent communication and interpersonal skills necessary for interacting with patients, physicians, supervisors, and other staff.
• Ability to project and maintain a professional image.
• Ability to work independently and excel as part of a team.
• Excellent customer service skills.
• Ability to complete work in a timely, accurate, and thorough manner.

Job Type: Part-time

Benefits:

• Paid time off

Education:

• High school or equivalent (Preferred)

Experience:

• Insurance verification: 2 years (Required)

Work Location: In person