Hybrid Verification and Pre-Authorization Specialist

Day in the Life of a Verification and Pre-Authorization Specialist

Verifying patients' benefits during intake, daily/monthly batches, individual requests, and when notified on ineligibility or coordination of benefits issues.

Research and processes eligibility requests according to business regulation, internal standards and processing guidelines. Verifies the need for prior authorizations or the need for retro billing.

Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.

Responsible for processing enrollment and eligibility for our clients before releasing for submission to payers.

Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices.

Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits.

Responsible to verify patients' insurances' benefits defined by departmental goals and insurance guidelines.

Must understand and comply with the rules regarding Coordination of Benefits.

Responsible for all eligibility related denials to identify trends to improve clean claim rates.

Responsible for multiple daily reporting of productivity indicators through various reporting tools.

Responsible to work all referrals within a 24/48-hour turnaround time from receipt.

Must complete and retrain base training.

Other duties as assigned.

Education and Experience Requirements

Must have had at least 2 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting.

General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.

Familiar with multiple payer requirements and regulations for utilizing benefits.

Hours and Schedule

Position will be fully in office during training period which may vary depending on candidate's ability to meet competency requirements. Once requirements have been met, the employee may transition to working three days in office per week and two days remote.

Benefits Package

Medical, Dental, and Vision Insurance

PTO

Variety of 401K options including a match program with no vesture period

Annual Continuing Education Allowance (in related field)

Life Insurance

Short/Long Term Disability

Paid maternity/paternity leave

Mental Health Day

Calm subscription for all employees