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.

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 include assisting front office with verification questions or concerns, resolving any coverage issues and updating patient EMR, entering insurance coverage accurately into patient EMR, serving as a liaison between the patient, facility, physicians, and other departments to ensure timely and accurate financial clearance of all accounts, verifying patient insurance coverage and benefits through online portals, phone calls, and other resources, verifying insurance eligibility along with benefits and ensuring all notifications and authorizations are completed by the surgery date, identifying patient accounts based on self-pay, PPO, HMO, personal injury, workmens compensation or other managed care organizations, collecting relevant data for eligibility and benefit verification including all ICD-10 and billable CPT codes per orders, communicating with internal and external individuals to obtain information, resolve benefit issues, and ensure accurate benefit information is obtained, responding to inquiries regarding patient accounts with appropriate and accurate information in a professional manner, ensuring accounts are financially secured by reviewing and documenting benefits, patient responsibilities, authorization requirements, and other relevant information, creating financial arrangements, alongside management, when a patient is unable to complete payment, responding promptly to requests and keeping open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution, collaborating with billing and coding departments to ensure correct processing of claims, calculating co-pay, and estimated co-insurance due from patients per the individual payer contract per the individual payer contract and plan as applicable, completing high-quality work while adhering to productivity standards, and performing miscellaneous job-related duties as assigned.

Knowledge, skills, and abilities include demonstrating 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 include high school diploma or GED, one (1) year of revenue cycle experience, and one (1) year of experience with insurance verification in a hospital/ASC setting.

Benefits include three medical plans, two dental plans, two vision plans, employee assistant program, short- and long-term disability insurance, accidental death & dismemberment plan, 401(k) with a 2-year vesting, PTO + holidays.