Responsibilities
• Verify patient eligibility and benefits via portal and/or phone call, including collecting referral and authorization requirements, across multiple payers, states, insurance products, and specialties within customer SLAs.
• Work closely with providers to collect accurate patient and medical records and communicate authorization decisions.
• Expediently complete prior authorizations using insurance portals or calling insurers directly.
• Ensure authorization is approved in a timeline manner by following up with insurers and providing additional information.
• Be responsible for handling multiple prior authorizations simultaneously and create process to ensure top of the line performance.
• Become a subject matter expert in prior authorization workflows for large insurers
• Communicate effectively across multiple stakeholders.
• Maintain strict confidentiality and adhere to HIPAA regulations in handling patient information.
Qualifications and Requirements
• Strong understanding of insurance policies and medical billing processes including CPT coding.
• Familiar with providers software, including Electronic Medical Record Systems (EMR/EHR) and Practice Management Systems (PMS)
• Experienced with HMOs, PPOs, POSs, EPOs, Medicare, Medicaid. Understanding of each through the referral and authorization process.
• Familiarity with navigating insurance portals.
• Strong phone etiquette and customer service skills, experience calling insurers to collect benefits and confirm authorization status.
• Strong work ethic to operate with urgency, work independently, be highly organized, detailed oriented and multi-task effectively.
• Can work efficiently under deadlines.
