Insurance Verification – Authorization Specialist

Role Overview

• The Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information.
• The Specialist will interpret benefit information and is familiar with insurance terminology to identify and document the correct plan.
• This position will request authorizations on payer websites, through fax submissions or over the phone and is responsible for follow-up, documentation, and re-authorizations as necessary.
• Responsibilities include initiating, following up, and securing authorizations sent to third-party payors
• Track and follow up on all pending authorizations within 7 – 14 days depending upon payer guidelines to expedite the claims process.
• Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patients
• Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in place
• Work closely with customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timely
• Verify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems
• Organize work to avoid lost revenue due to filing limitations
• Review and verify all insurance plans and confirm patient's eligibility and benefits specific to DME.
• Review and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented in HDMS / OnBase.
• Input the correct Payer Plan ID# and enter data into systems to ensure accurate billing for current and future services.
• Determine the extent of liability for insurance plans, coordination of benefits, and personal responsibility.
• Other duties as assigned.

Requirements

• Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.
• Organizational skills
• Medical terminology
• Good troubleshooting skills
• Ability to work as a team
• Ability to independently meet tight deadlines in a project-based atmosphere
• Follows department processes and procedures
• Highly motivated and detail-oriented

Benefits

• Health plan options that include an employer contribution
• Health Savings Account (HSA)
• Healthcare and Dependent Care Flexible Spending Accounts (FSA)
• Dental and Vision premiums covered by InfuSystem
• Life Insurance, STD & LTD
• Paid Parental Leave
• Adoption and Fertility Assistance
• 401(k) with a specified Company Match
• Employee Stock Purchase Program
• Tuition Assistance
• Generous Paid Time Off plan
• Employee Assistance Program
• Competitive Pay
• Employee Referral Bonus