Hybrid Verification and Pre-Authorization Specialist

Crossroads Treatment Centers•Greenville, SC

6d•Hybrid

About The Position

Crossroads Treatment Centers is seeking a Hybrid Verification and Pre-Authorization Specialist to join their team. This role is crucial in verifying patient benefits, processing eligibility requests, and ensuring compliance with regulations. The specialist will coordinate with internal departments, manage patient information, and understand payer requirements for accurate billing. The position involves daily reporting of productivity and requires a turnaround time of 24-48 hours for referrals. Training will be conducted in-office, with a potential transition to a hybrid work model (three days in office, two days remote) upon meeting competency requirements.

Requirements

At least 2 years of 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.
Familiarity with multiple payer requirements and regulations for utilizing benefits.
Good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses.

Responsibilities

Verifying patients’ benefits during intake, daily/monthly batches, individual requests, and when notified on ineligibility or coordination of benefits issues.
Researching and processing eligibility requests according to business regulation, internal standards, and processing guidelines.
Verifying the need for prior authorizations or the need for retro billing.
Coordinating with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification, and other files as necessary.
Processing enrollment and eligibility for clients before releasing for submission to payers.
Understanding and adhering to state and federal regulations and system policies regarding compliance, integrity, and ethical billing practices.
Verifying patients’ insurances’ benefits defined by departmental goals and insurance guidelines.
Understanding and complying 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.
Working all referrals within a 24/48-hour turnaround time from receipt.
Completing and retraining base training.
Other duties as assigned.