Job Description:
• 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:
• Phone etiquette and customer service skills, experience calling insurers to collect benefits and confirm authorization status.
• Has understanding with HMOs, PPOs, POSs, EPOs, Medicare, Medicaid through the referral and authorization process.
• Familiarity with navigating insurance portals.
• Demonstrates strong understanding of insurance policies and medical billing processes including CPT coding.
• Work ethic to operate with urgency, work independently, be highly organized, detailed oriented and multi-task effectively.
• Work efficiently under deadlines.
• Clear and coherent both written and verbal communication skills in English.
Screening Criteria:
• Minimum of one (1) year experience with medical billing and/or understanding of benefits including deductibles, co-insurance, out of pocket and benefits exclusions.
• Experience in providers software, including Electronic Medical Record Systems (EMR/EHR) and Practice Management Systems (PMS).
• Must have a stable employment history.
