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
- 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.
Screening Criteria
- Minimum of one (1) year of experience with medical billing and/or understanding of benefits including deductibles, co-insurance, out of pocket and benefits exclusions
- Must have a stable employment history.
