Medical Insurance Authorization & Verification Specialist

Position Title: Medical Insurance Authorization and Verification Specialist

Reports To: Authorization & Verification Manager

FLSA Status: Non-Exempt

Position Type: Full-Time

Work Schedule: Monday to Friday - 40- hour week

Direct Reports: None

Position Summary:

Ensure patients’ demographic, medical insurance and/or other payer information is accurate in the electronic medical records system. Perform authorization and verification reviews in a timely manner and communicate cost and coverage information with patients, insurance companies and other payers.

Essential Duties and Responsibilities:

• Verify insurance eligibility and benefits as it relates to the radiology services rendered.
• Obtain all referrals and authorizations as needed from payer for services.
• Calculate patients’ out-of-pocket expense and inform patients of their financial responsibility for services to be rendered.
• Resolve patient and payer requests, inquiries and concerns in an expedient and respectful manner.
• Ensure all authorizations and verifications have been completed and recorded in the system in a timely manner to avoid scheduling issues.
• Monitor schedules for add-on patients, discrepancies, verification and authorization conflicts that may affect scheduled procedures.
• Inform management of any pending authorization or verification issues which might delay ability to perform scheduled procedures.
• Maintain knowledge of and work in compliance with all HIPAA guidelines.
• Perform related duties as assigned by supervisor.
• Maintain compliance with all company policies and procedures

QUALIFICATIONS

Formal Education:

• High School Diploma or equivalent required

Related Work Experience:

• 2 – 3 years’ medical insurance authorization/verification experience preferred.

Licenses or Certifications:

N/A

Specialized Knowledge/Skills:

• Knowledge of medical terminology such as guarantor, primary, group ID and subscriber ID.
• Knowledge of payable diagnosis codes for ordered procedures.
• Knowledge of medical billing terminology and procedures.
• Excellent typing (minimum 40 WPM) and computer usage skills, including Microsoft Office.
• Ability to learn radiology information systems (RIS) and/or electronic medical record (EMR) systems.

Competencies:

• Customer service focus – ability to relate with people of diverse backgrounds, and provide excellent customer service and solutions to problems.
• Promote teamwork by working collaboratively with colleagues and management to achieve shared goals.
• Attention to detail.
• Sense of urgency.
• Professional and efficient verbal and written communications.
• Ability to work independently, prioritize and perform several tasks at once without losing concentration.
• Mathematical aptitude to ensure accurate calculations of deductibles, co-pays and patient out-of-pocket expenses.

Physical Requirements:

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards; including meeting qualitative and/or quantitative productivity standards, and maintaining regular in-person punctual attendance.
• Light physical effort. Requires long periods of sitting. Must be able to lift and carry up to 25 lbs.
• Constantly uses and operates standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Must be able to talk, listen and speak clearly on the telephone and in person with co-workers, patients, customers and other visitors.

This description reflects management’s assignment of essential functions. It does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.