Insurance Verification & Authorization Agent

Job Description

Job Description

Join a Team That Makes a Difference at Optimus Health Care!

Are you passionate about providing high-quality, patient-centered care? Optimus Health Care—the largest provider of primary health care services in Fairfield County—is looking for dedicated professionals to join our team! With multiple locations in Bridgeport, Stratford, and Stamford, our mission is to be a lifelong health care partner, dedicated to achieving optimal wellness for the communities we serve.

Optimus Healthcare is looking for a Full Time Insurance Verification & Authorization Specialist  to join our team in Stratford, CT location.

The Insurance Verification & Authorization Agent is a member of our BH care team responsible for working with Providers, Nurses, and Clinical Support staff to ensure a complete and timely insurance and authorization flow process. Assure that pre-work is performed before the patient arrives by verifying demographic and insurance information to ensure prompt payment of services to Optimus. This position will contact patient’s insurance company to verify coverage levels and works with patients to walk them through their benefits information. The position works to ensure that patients have been authorized for specialty services and office visits. May act as a liaison between the patient, provider/referring provider, BH provider, and other parties involved in the plan of care. Appropriately link referrals for identified visits.

Essential Functions & Responsibilities:

Responsible and accountable for verification of insurances to ensure billing of services.

1. Review appointment schedules to identify insurance for verification, with particular insurance plans.
2. Verify insurance coverage, copays and deductibles through employer, insurance carrier, and/or on line verification including the amounts “met to date” and any pre-authorization requirements.
3. Verify coordinate of benefits in using the “birthday rule”, if patient is a minor. 
4. Update patient notes in the system with pertinent insurance changes or concerns, as a means to ensure account history is available for respective departments.
5. Works closely and assists the Practice Manager with related special projects as necessary, including billing participation in performance improvement initiatives
6. If patient qualifies for entitlement refer (by task) to FCC.
7. Responsible to communicate with patient on insurance coverage concerns and any additional information required by carrier to process payment.

1. Perform other related duties as required.

Additional General Requirements:

Great computer skills.

Familiarity with EMR, helpful.

Commitment to maintenance of patient privacy

Flexibility to work at other OHC sites as necessary.

  Job Qualifications/Requirements:

Education: High School diploma/GED, Associates degree preferred.