Authorization & Verification Specialist - Acute Team

Continuumrx is currently recruiting employees in Knoxville, Tennessee to support our Acute Authorization and Verification Team!

• The Verification Specialist - Specialty role is responsible for processing benefit verification of benefits for acute patients.
• The primary role of the Authorization Specialist is to review, process, and follow to completion the requirement of obtaining prior authorizations for services. This includes PBM authorizations.

• Verifies benefit coverage and as appropriate, financial responsibility.
• Identifies out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verification.
• Documents all patient interaction in EMR as a billing note.
• Serves as a resource and problem resolution expert for patients, Intake and Sales.
• As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Document information in EMR and communicates as appropriate to team members.
• Assists with Ready To Bill (RTB) as appropriate.
• Performs other duties and special projects, as assigned.
• Complete understanding of confidentiality with respect to Company proprietary information as well as information concerning patient/client care; complying with all federal and state laws as apply to confidentiality of protected health information (PHI) and electronic protected health information (EPHI); and following HIPAA guidelines regarding readily identifiable protected health information.

• Coordinates with the Intake Specialists and the Pharmacy Team to identify and process requests for services requiring Prior Authorization and/or Pre-Determination for services rendered.
• Reviews each request for Prior Authorization and insures that the proper supporting documentation and forms/documents are completed.
• Processes Prior Authorizations via Fax, computer or phone call as required by the specific payers.
• Maintains an organized process for documenting and tracking all requested prior authorizations.
• Maintains an organized process for timely follow-up and troubleshooting of all pending Prior Authorizations.
• Documents in the patient record all prior authorizations, expiration dates and other information as required.
• Communicates with the Revenue Cycle Team and Admission Specialists any prior authorization denials and insures prompt follow-up.
• Maintains a process to review newly accepted patients for a "second check" to prevent missing prior authorization requests.
• Effectively identify and communicate to supervisor when assistance is needed (including, but not limited to system function, training, etc.).
• Observes legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA).
• Understands and provides exceptional customer service to clients, patients, and payers.
• Exhibits a positive, courteous, respectful and helpful attitude to clients, co-workers, and management team.
• Promotes company culture by adhering to all policies and procedures.
• Adapts to and demonstrates the ability to deal with frequent changes in the work environment.
• Other tasks/duties as assigned.
• Complete understanding of confidentiality with respect to Company proprietary information as well as information concerning patient/client care; complying with all federal and state laws as apply to confidentiality of protected health information (PHI) and electronic protected health information (EPHI); and following HIPAA guidelines regarding readily identifiable protected health information.

• 2 or more years of experience in healthcare reimbursement with focus on insurance verification and authorizations.
• Experience with coordination of benefits, including but not limited to HMO, PPO, TPA, state and federal payors; preferred but not required.
• Prior work in specialty or home infusion, homecare or related field; preferred but not required.
• Strong computer skills (Microsoft Word, Excel, PowerPoint)
• Exceptional communication - verbal and written
• Exceptional interpersonal skills
• Exceptional organizational and process skills
• Ability to work well under pressure, meet timelines, and completes assigned projects
• Exceptional critical thinking and problem solving skills
• Proven performance, history in related field Exceptional attention to detail and demonstrated results
• Exceptional track record of customer satisfaction