Position: Insurance & Authorization Specialist
Classification: Non-exempt
Reports to: RCM Manager
Hours: Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m.
Position Summary
The Insurance & Authorization Specialist is responsible for verifying patient’s health care benefits by obtaining the eligibility status, benefit details, and authorization requirements. The Insurance & Authorization Specialist is equally responsible for obtaining and communicating any necessary authorizations or referrals for services performed or durable medical equipment dispensed.
Essential Functions
- Verifies patient insurance coverage timely utilizing phone or online resources to ensure necessary procedures are covered.
- Enters data timely in an accurate manner into the EMR system and verifies that existing information is accurate.
- Serves as a valuable resource to patients, providing them with pertinent information regarding their coverage.
- Submits all necessary authorization requests for services prior to being rendered.
- Ensures all pertinent medical documentation is accurate and present prior to submission.
- Assures authorizations or referrals have been approved with the proper CPT and ICD10 codes prior to services being rendered.
- Follows up with pending authorizations on a regular basis to obtain the current status or to be informed of any action needed in order to obtain the authorization approval.
- Communicates any authorization denials to the appropriate staff.
- Keeps patients abreast of the current status of their authorization if waiting time has exceeded the usual and customary expected time.
- Documents authorization details, status, and end result into EMR timely and prior to services being rendered.
- Handles any discrepancies, errors, or omissions of authorization denials.
- Schedules peer to peers with providers and communicates such meetings appropriately.
- Works collaboratively with the entire billing department to meet company goals.
- Participates in educational activities and attends regular staff and department meetings.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Stays abreast with current and upcoming payer billing requirements and regulations.
Competencies
- Strong understanding of medical terminology
- Working knowledge of payer billing requirements and regulations
- Strong organizational and multitasking skills
- Solid attention to detail to ensure accuracy of information
- Must be able to work independently and show leadership in decision making
- Effective communication and listening skills
- Excellent computer skills, including Word, Excel, and Google Drive
Supervisory Responsibility
This position has no supervisory responsibilities.
Work Environment
This job operates in a professional, clerical-administrative office environment. This role routinely uses standard office equipment such as computers, phones/headsets, photocopiers, filing cabinets, and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand, walk; use hands to finger, handle or feel; and reach with hands and arms. This position may require sitting for long periods of time during shift.
Travel
Travel is not required for this position.
Required Education and Experience
- High school diploma
- A minimum of 2 years of successful experience within a medical billing setting working with insurance companies, and have extensive knowledge of different types of coverage and policies
- 1 – 2 years of EMR experience
Preferred Education and Experience
- 3+ years experience in a medical billing setting and in a similar role
Additional Eligibility Qualifications
None required for this position.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.