Authorization/Insurance Verification Spec.
About The Position
Waikiki Health is seeking a full-time Authorization/Insurance Verification Specialist. This role is crucial for optimizing professional billing, collections, and accounts receivable workflows. The specialist will ensure revenue integrity by verifying patient insurance, confirming primary care provider status, and obtaining necessary service authorizations. Additionally, this position involves collaborating with executive leadership on significant financial projects, such as the annual HRSA Uniform Data System (UDS) Report, and providing comprehensive support to clinical and administrative teams.
Requirements
- High school diploma or equivalent.
- A minimum of 2 years of experience in medical billing and/or follow-up with all types of insurance carriers, including Medicare and Medicaid.
- Complete understanding of AR and PMS system.
- Familiarity with Microsoft Office programs, including Excel and Outlook.
- Knowledge of current Billing Operating System (Athena).
- Verifies insurance and PCP assignments at least 3 days prior to the set appointment.
- Communicates in a clear and timely manner with the Director of Revenue Cycle.
- Proof of TB skin test or chest x-ray (Hep B is optional).
Responsibilities
- Verifies insurance eligibility and confirms Primary Care Provider (PCP) designations.
- Contacts patients directly to gather missing details or facilitates calls to update PCP status prior to appointments.
- Proactively reviews patient schedules to identify, submit, and secure all required medical and service authorizations before patients are seen by providers.
- Utilizes system knowledge to research, troubleshoot, and resolve upstream and downstream revenue cycle issues within the AthenaNet platform.
- Executes specialized financial research and data projects, including the preparation of critical HRSA UDS Report tables.
- Educates patients, staff, and payers on complex financial processes.
- Creates clinical communication cases for data corrections.
- Assists with training new revenue cycle employees.
- Other duties as assigned.
Benefits
- Health insurance (Employee only) 100% premium paid once eligible.
- 13 Paid holidays
- Parking included
- 403(b) Retirement Plan Participation effective within 4 weeks of employment
- Matching is offered once eligible with a 3-year vesting period
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
