Coordinator, Benefits Eligibility and Authorization

NAVISTA

5d•$21 - $28

About The Position

What Benefits Eligibility and Authorization contributes to Cardinal Health Practice Operations Management oversees the business and administrative operations of a medical practice. This position is responsible for reviewing the physician’s daily schedule and obtaining verification of patients’ insurance benefits for their scheduled visits. They will also obtain authorization for all requested procedures, tests, drugs, etc. The Coordinator, Benefits Eligibility and Authorization may be asked to perform other duties if necessary & must be knowledgeable of a variety of insurance plans and policies

Requirements

4-8 years of experience, preferred
Bachelor's degree in related field, or equivalent work experience, preferred
Knowledge of medical terminology.
Familiar with Oncology, Urology, Chemotherapy and Radiation Billing preferred
Experience with computerized billing software and interpreting EOBs
Working knowledge of ICD-9/ICD-10, CPT, HCPCS, and CPT coding.
Experience with GE Centricity preferred
Knowledge of computer/telephony support, preferably in a healthcare environment preferred
Strong customer service background, preferably in a healthcare environment.
Excellent verbal communication skills.
Competence with computer processing functions and other standard office equipment.
Ability to manage and prioritize multiple tasks.
Ability to calmly and professionally resolve customer issues with diplomacy and tact.
Ability to work independently with minimal supervision.
Strong organizational skills.
Understanding of managed care contracts and fee schedules, including Medicare and Medicaid.

Responsibilities

Verify all new, returning, and annual patient eligibility to confirm insurance status and benefits including patient responsibility such as deductible, out of pocket, copay and coinsurance prior to services rendered.
Communicate with patients, front end staff, physicians & payors as needed in order to obtain updated insurance and/or clinical information.
Submit authorizations for all internal and external orders including, but not limited to, radiation, chemotherapy, PET/CT, urology and scans.
Follow up within 48 hours on any existing authorizations that are pending approval.
Ensure proper documentation outlining all steps taken to ensure authorizations have been submitted, followed up on and obtained.
Upon approval, enter all authorization information into the billing system and attach confirmation into the patients account in registration overlay.
Take any action necessary for any denials received by the payor to inform the clinician of changes that may need to happen to not delay patient care.
Complete any pre-service appeals to obtain paying approval based on medical necessity.
Communicate effectively with all Revenue Cycle Management staff and clinical staff to ensure appropriate treatment can be provided, claims can be processed accurately and timely payment received.
Maintain a high level of confidentiality for patients in accordance with HIPAA standards.
Coordinate with clinical staff to ensure patients are contacted prior to appointments informing them of any treatment schedule changes if necessary.
Effectively completes other duties and projects as assigned.
Regular attendance and punctuality.
Execute all functions of the role with positivity and team effort by accomplishing related results as needed.
Effectively completes other duties and projects assigned.