Responsibilities
- Verifies patient insurance coverage timely utilizing phone or online resources.
- Submit prior authorizations to insurances in timely matter via payer specific portals and vendors
- Ensures all pertinent medical documentation is accurate and present prior to authorization submission.
- 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.
- Handles any discrepancies, errors, or omissions of authorization denials and files appeals when necessary for overturn of adverse decision.
- Participates in educational activities and attends regular staff and department meetings.
- Exhibit and manage excellent turn-around time in order to ensure timely authorizations.
- Consistently work in a positive and cooperative manner with fellow team members and management.
- Demonstrate flexibility to perform duties wherever volume deems it necessary.
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner.
- Document activities appropriately in process notes.
- Participates in the Quality Assurance plan.
- Complies with applicable CLIA and HIPAA regulations.
- Stay up to date with SOPS
- Complies with all company and department policies and procedures
- Contributes to a positive work and team culture
Qualifications
- 3-5 years of experience working in medical billing, health insurance or collections with demonstrated results.
- Insurance billing experience is preferred.
- Good problem solving and decision-making skills.
- Excellent customer service and phone skills.
- Excellent time management, organizational, communication, multitasking and teamwork skills.
- Working knowledge of ICD-10, CPT and HCPCS coding (preferred but no required).
- Ability to successfully navigate between multiple systems throughout the course of the workday this includes but is not limited to billing software, written Standard Operating Procedures and payer portals.
- Preferred authorization experience
Physical & Lifting Requirements
- Lifting Requirements - light work or exerting up to 20 pounds of force frequently.
- Physical Requirements - stationary positioning, moving, operating, ascending/descending, communicating and observing.
- Use of equipment and tools necessary to perform essential job functions.
