Authorization Rep

Insurance Verification Specialist

Revenue Cycle Management is looking for an Insurance Verification Specialist to join our team. Hybrid/Remote opportunity after 90 days of in-person training.

SUMMARY: The Insurance Verification Specialist is responsible for verifying the patient's insurance coverage, ensuring surgery and procedures are covered by an individual's insurance plan. Creates cost estimates prior to the surgery date and communicates cost to patients. In addition to, entering and verifying accurate data and updating patient benefit information in the Electronic Medical Records (EMR).

Essential Functions

• Assists front office with verification questions or concerns
• Resolves any coverage issues and update patient EMR
• Enters insurance coverage (co-payments, deductibles, etc.) accurately into patient EMR
• Serves as a liaison between the patient, facility, physicians, and other departments to ensure timely and accurate financial clearance of all accounts
• Verifies patient insurance coverage and benefits through online portals, phone calls, and other resources
• Verifies insurance eligibility along with benefits and ensures all notifications and authorizations are completed by the surgery date
• Identifies patient accounts based on self-pay, PPO, HMO, personal injury, workmens compensation or other managed care organizations
• Collects relevant data for eligibility and benefit verification including all ICD-10 and billable CPT codes per orders
• Communicates with internal and external individuals to obtain information, resolve benefit issues, and ensure accurate benefit information is obtained
• Responds to inquiries regarding patient accounts with appropriate and accurate information in a professional manner
• Ensures accounts are financially secured by reviewing and documenting benefits, patient responsibilities, authorization requirements, and other relevant information
• Creates financial arrangements, alongside management, when a patient is unable to complete payment
• Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution
• Collaborates with billing and coding departments to ensure correct processing of claims
• Calculates co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable
• Completes high-quality work while adhering to productivity standards
• Performs miscellaneous job-related duties as assigned

Knowledge, Skills, and Abilities

Demonstrates ability to use basic computer functions, technology and Microsoft office (excel, word) Broad knowledge of the content, intent, and application of HIPAA, federal and state regulations Ability to work independently with little or no supervision as well as function within a team Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization Good communication skills (verbal / written) providing a great patient experience Ability to work effectively in a fact paced environment Strong knowledge of managed care, medical terminology, CPT Coding and ICD10 Demonstrates use of appropriate modifiers, HIPAA regulations, and insurance verification procedures Knowledge of payor guidelines including reading, understanding and interpreting medical records and payor requirements etc. Ability to think critically, assess problems and provide problem resolutions Demonstrates attention to detail, accountability, people skills, problem solving and decision-making skills

Education and Experience

High School Diploma or GED One (1) year of revenue cycle experience One (1) year of experience with insurance verification in a hospital/ASC setting

Benefits

3 Medical Plans 2 Dental Plans 2 Vision Plans Employee Assistant Program Short- and Long-Term Disability Insurance Accidental Death & Dismemberment Plan 401(k) with a 2-year vesting PTO + Holidays

Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Premier Medical Resources where passion and career meet.