Insurance Verification and Prior Auth Specialist

Insurance Verification and Prior Auth Specialist Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems. Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with internal departments, physician offices, patients and third-party payers to complete the pre-certification process. Identifies out of pocket amounts (i.e., copay, deductible, co-insurance), determining the correct coordination of benefits, identifying if a replacement or supplemental plan exists, identifying termed coverage, and identifying if the patient\'s plan is considered out of network coverage. Collaborates with internal departments to provide account status updates, including expected out of pocket amounts, coordinate the resolution of issues, and appeal denied authorizations. Ensures services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance. Notifies ordering providers if authorization/certification is denied. May need to coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures. Maintains files for referral and insurance information, and enters referrals into the system. Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans. Runs system-generated reports to verify insurance verification/authorization is being done timely prior to the patient\'s date of service; verifies the insurance benefits and eligibility either by phone or online for every patient that is scheduled Responds to patient calls about how out of network insurance is handled and provide patient with letter explaining this if necessary. May need to respond to patient inquiries about their insurance benefits. Assists physician’s office staff with any insurance benefit questions and educate them on any changes to the insurance companies’ verification/pre-certification process for the facility. Ensures insurance information is verified and entered into the billing system. Works with Billing Department to assure all insurance information is entered so claims are not denied. May help research any claim issues. Other duties as assigned. Secondary Job Functions: Attend meetings and training sessions Maintain confidentiality of patient and financial information by utilizing HIPAA guidelines and regulations Adheres to all Federal, State, and Local laws and regulations as well as policies set forth by Ohio Gastroenterology Group Inc and its related parties Knowledge, Skills and Abilities Knowledge of third-party payers and prior-authorization requirements Understanding of basic medical terminology and procedures Proficient use of office equipment, such as copier and fax machine, phones, etc. Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical records systems. High attention to detail and the ability to multi-task. Ability to work independently with minimal supervision and to manage multiple priorities. Strong written and verbal communication skills Ability to effectively communicate with a variety of people under stressful circumstances. Neat appearance, professional demeanor and pleasant voice Credentials and Experience Must have high school diploma or equivalent One (1) year of experience and relevant knowledge of revenue cycle functions, insurance eligibility, or prior authorization in a healthcare setting preferred Experience with eClinicalWorks a plus Physical Demands Must be able to bend over (frequent), climb stairs (frequent), sit (frequent), stand (frequent), stoop (frequent), walk (frequent) and type on keyboard (frequent). Minimal medical office exposure that may require contact with adult patients Office workstation environment with numerous employees [1] Critical features of this job are described under this heading. They may be subject to change at any time due to reasonable accommodation or other reasons, Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Ohio Gastroenterology Group, Inc.