Responsibilities
- Coordinate with insurance companies to secure authorizations for medical services, procedures, and medications.
- Confirm coverage, benefits, and any special requirements (e.g., documentation of medical necessity) for timely care delivery.
- Update patient files in the clinic’s electronic health record (EHR) system with authorization status, eligibility details, and payer interactions.
- Collect necessary documentation from providers and respond to inquiries regarding insurance and authorization requirements.
- Track denied claims, initiate appeals, and follow through to resolution to minimize disruptions in patient care and financial losses.
- Provide timely updates on insurance approvals or denials, clarifying financial obligations when necessary.
- Ensure all processes align with HIPAA, healthcare regulations, and internal policies.
- Monitor timelines to avoid delays and prioritize urgent cases efficiently.
- Accurately enter and track financial activities in relevant systems according to departmental policies.
- Organize and maintain efficient workflows for timely follow-up on all client account tasks.
- Work closely with internal departments to resolve payment discrepancies and improve financial operations.
- Maintain exceptional service levels when interacting with patients, clinical staff, and third-party payers.
- Attend virtual meetings and complete required training to stay updated on processes and regulations.
Qualifications
- Understanding of HIPAA and patient confidentiality standards.
- Experience handling patient or client inquiries professionally, ideally in a healthcare setting.
- General knowledge of Microsoft Excel, Word, and email platforms (e.g., Outlook, Gmail).
- Ability to manage multiple tasks, track deadlines, and prioritize work in a remote environment.
- Demonstrates initiative and drive to achieve goals without constant supervision.
- Maintains a systematic approach to managing tasks and responsibilities efficiently.
- Strong time management skills to execute tasks effectively to meet deadlines and maintain workflow.
- Ability to analyze challenges and develops practical solutions in a timely manner.
- Willing to learn and integrate new technologies and procedures as needed.
Screening Criteria
- At least one (1) to two (2) years of experience in healthcare, insurance, medical billing, or related fields.
- Must have a stable employment history.
