Benefits/Prior Authorizations Specialist

Premier Women’s Care of Southwest Florida

OB/GYN Care Center FL 221

Benefits/Authorizations Verification Specialist

Job Description

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Job Title: Benefit/Prior Authorizations Verification Specialist (Non-Exempt Position)

General Summary of Duties: Contacts third party companies or utilizes web-based insurance resources to obtain plan benefits and authorizations for medical procedures, devices, and medications. Completes authorizations for a variety of procedures. Verifies coverage as plan dictates, deductible, coinsurance, co-pay, verification of in/out of network benefits and obtains prior authorization referral requests for HMO/PPO, commercial payers, Government plans (Medicare/Medicaid/Tricare), Medicare replacement plans and other third-party insurances. Conducts third party prior authorizations for medications.

Reports to: Billing Manager

Supervises: None

Typical Physical Demands:

• Requires prolonged sitting, some bending, stooping, and stretching.
• Requires hand-eye coordination and manual dexterity enough, operate a keyboard, copier/scanner, telephone, and other office related equipment.
• Requires normal range of hearing and eyesight and necessary to view and type on a computer screen for long periods of time and to prepare and communicate appropriate reports.
• Required ability to respond to difficult patient and medical insurance inquiries

OSHA Employee Exposure Classification: 3

Typical Working Conditions: Standard medical office working conditions. Involves frequent telephone communication with insurance companies, medication distributors, healthcare product suppliers, patients. Involves face-to-face communication with providers/provider staff as needed.

Example of Duties: (This list does not include all duties that may be assigned)

• Contacts primary and secondary insurance payers to collect insurance benefits, coverage, maximum benefits/deductibles and current use, authorization requirements, and other pertinent information
• Documents accurately in Athena for accurate diagnosis to obtain third party authorization.
• Responds to correspondence, phone calls, and patients in a courteous and timely manner.
• Able to review EHR for other assigned duties such as appointment type verification, closing OB episodes.
• Enters charges for a variety of in office procedures
• Notifies patients if authorizations, referrals, or co-payments are necessary.
• Maintains comprehensive supporting documentation and reports for insurances verified in designated files.
• Acts as a liaison between patient, physician office, and third parties to assist patient concerning financial responsibility.
• Answers telephone, screen calls, take messages and provides information for other assigned tasks as needed.
• Attends meetings as required.
• Performs other duties as assigned

Performance Requirements

Knowledge:

• Clinical documentation in Athena EHR, medical terminology as well as ICD-10 and CPT codes
• Strong understanding of insurance policies (HMO, PPO, Medicare, Medicaid, etc.)
• Grammar, spelling and punctuation to type information
• Medical office appointment types
• Third party vendor needs for information

Skill:

• Electronic health record and computer applications
• Proper phone etiquette when contacting insurance carriers, patient, or physician’s offices for necessary information.

Ability:

• Acquire accurate benefit and eligibility information
• Read, understand, and follow written and verbal instruction
• Establish and maintain effective working relationship in a collaborative manner with patients, co-workers, and the public.
• To speak clearly and concisely

Education:

High School diploma or GED

Experience:

Two (2) years of work experience in the medical office environment

Computer literacy to include Electronic health record, word processing. Athena expereince desireable.

Certification/Licensure:

None required.

Alternative to Minimum Qualifications:

Additional appropriate education may be substituted for one year of work experience.

March 2019/revised July 2020/April 2024

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Education:

• High school or equivalent (Required)

Experience:

• benefits verification: 1 year (Required)
• Customer service: 2 years (Preferred)

Location:

• Fort Myers, FL (Required)

Work Location: Remote