Insurance Authorization Specialist

Insurance Verification Specialist

Verify insurance information by insurance portals and or calling insurance companies on occasion. Obtain authorization from a managed care carrier for patients before exams in the office. Contact the primary care physician's office to obtain authorization or referral for an office visit (as required by contract). May contact the patient when additional information is required of them. When authorization is obtained, a referral must be generated (if required) at the visit level in the EMR/EHR software referral module and linked to the appropriate visit and patient procedure. Perform other duties like checking in patients or other duties assigned.

Job Requirements:

• Performs telephonic support for online authorization of routine services
• Provides direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activities
• Receive, track and obtain insurance authorization from in-network and out-of-network insurance carriers
• Strong understanding of managed care principles and insurance verification processes.
• Processing pre-service authorizations for surgical procedures
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Resolves pre-certification denials and submits letter of medical necessity when needed
• Do pre-certification for surgical procedures (call insurance company to verify if deductible met, fax clinical to insurance company pre-certification department to obtain authorization for procedure).
• Assist billing department to obtain retro referrals for services that were rendered (either office visits or surgical procedures). This may include in-office procedures, office visits or outpatient surgical procedures.
• May explain benefits information to patients who arrive to visit and may not understand their portion of the bill (co-pay, deductibles, etc.).
• Knowledge of health insurance concepts (i.e., HMO, PPO, etc.).
• Ability to multi-task, prioritize work and make sound judgments. Ability to remain patient during long periods of telephonic hold times.

Knowledge of all clinical systems that interface with our EHR/EMR and practice management system. Skilled in Office Windows applications (Word, Excel, etc.) Proficient in ICD-9/ICD-10 and CPT codes. Ability to perform all tasks paying attention to detail. Excellent customer service skills. 5+ years experience in insurance verification in a clinical setting.

Schedule:

Full-Time: Monday-Thursday 8am-5:00pm / Friday 8am to 12:00pm

Location: Fort Worth, TX