Insurance Auth Spec

Lincare•Texarkana, TX

29d

About The Position

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.

Requirements

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
Computer entry experience necessary

Nice To Haves

Medical billing/coding experience preferred
Health insurance authorization submission experience preferred

Responsibilities

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