Job description

The Verification and Pre-Authorization Specialist is responsible for verifying patient’s benefits during intake, daily/monthly batches, individual requests, and when notified on ineligibility or coordination of benefits issues. They also research and process eligibility requests according to business regulation, internal standards and processing guidelines. Verifies the need for prior authorizations or the need for retro billing. In addition, they also coordinate with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.

Essential Duties and Responsibilities include the following and other duties that are assigned.

· Verifying patients’ benefits during intake, daily/monthly batches, individual requests, and when notified on ineligibility or coordination of benefits issues.
· Research and processes eligibility requests according to business regulation, internal standards and processing guidelines. Verifies the need for prior authorizations or the need for retro billing.
· Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary.
· Responsible for processing enrollment and eligibility for our clients before releasing for submission to payers.
· Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices.
· Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits.
· Responsible to verify patients’ insurances’ benefits defined by departmental goals and insurance guidelines.
· Must understand and comply with the rules regarding Coordination of Benefits.
· Responsible for all eligibility related denials to identify trends to improve clean claim rates.
· Responsible for multiple daily reporting of productivity indicators through various reporting tools.
· Responsible to work all referrals within a 24/48-hour turnaround time from receipt.
· Must complete and retrain base training.
· Other duties as assigned.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Position requires constant mental alertness, attention to detail, and high degree of accuracy required in completing all assignments. Strong problem-solving skills. Smart, driven, exceptional work ethic. Must be able to follow oral and written instructions and follow –through on all assignments. Excellent organizational skills. Highly detailed-oriented. Ability to work well in a group setting and independently.

Education and/or Experience:
· Must have had at least 2 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting.
· General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology.
· Familiar with multiple payer requirements and regulations for utilizing benefits.

Language Skills:

Ability to read, analyze, and interpret human service periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Excellent communication and interpersonal skills.

Mathematical Skills:

Ability to calculate figures and amounts such as percentages, mean, mode and median ability to draw and interpret graphs.

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee occasionally lifts/carries paperwork, files, office supplies, up to 20 lbs., pushes/pulls exerting up to 5-10 lbs. force, opening doors, file drawers, pushing files in drawers, and kneeling/crouching and/or ability to reach lower file drawers, file stretching to store of retrieve materials. Specific vision abilities required by this job include close vision and the ability to adjust focus. Frequent sitting at desk or computer while typing, completing paperwork, or meeting with patients.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Normal office environment where there is no physical discomfort cue to temperature, dust, noise, and the like. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Weekend availability

Application Question(s):

• What are your pay expectations?
• Please describe your background with medical billing and verifying insurance eligibility with physician claims.
• What payors have you worked with?

Work Location: In person

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