Insurance Auth Spec

United States·Centralized Csr Mo-Mo66 - Grain ValleyNormalmid

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Quick Summary

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The Insurance and Authorization Specialist is responsible for obtaining benefits and eligibility information and submitting authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements. For Part-Time positions, the standard hours will be determined at hire with a minimum of 17.5 hours and maximum of 35 hours with potential week to week fluctuation if desired.

Responsibilities

~2 min read

→Run eligibility and benefits
→Call insurance to go through individual HCPCs and Policy
→Analyze paperwork to ensure that all required documentation has been received and that patient qualifies under the insurance guidelines
→Work with local center or directly with referring provider if additional documentation is needed
→Review paperwork for completion
→Request authorization and follow up on authorization
→Attach all documentation to the EMR system via a systematic naming process
→Input thorough notes in EMR system
→Communicate with the local center on authorization process
→Use critical thinking skills and payer knowledge to determine what dates to submit for authorization for existing patients needing authorization
→Work on getting paperwork for re-authorization 30-45 days before expiration
→Request authorizations 7-14 days before expiration, will receive report from Supervisor
→Assist in calling centers for missing information or corrections
→Answer phones and email questions from the centers
→Works on denials received
→Work with RBCO to determine denials and insurance issues
→Communicate professionally with patients, medical professionals, and co-workers
→Spend time getting eligibility and correct information on payers that require a more in-depth review

→ Read and analyze documents such as patient orders
→ Comprehend pharmacy prescription terminology
→ Effectively communicate with co-workers and patients alike
→ Help with the training of employees
→ Calculate figures and amounts in reference to frequency and doses dispensed
→ Apply common sense understanding to carry out oral and written instructions

High school diploma or general education degree (GED), related experience and/or training, or equivalent combination of education and experience
Medical billing/coding experience preferred
Health insurance authorization submission experience preferred
Computer entry experience necessary