Insurance Authorization Specialist

Texas Health Care C•Cleburne, TX

6d•Onsite

About The Position

The Insurance Authorization Specialist is responsible for verifying insurance information, obtaining authorizations from managed care carriers for patient exams, and contacting primary care physician offices for necessary authorizations or referrals. This role may also involve contacting patients for additional information, generating referrals in the EMR/EHR system, and performing other administrative duties such as checking in patients. The position requires strong knowledge of health insurance concepts, excellent customer service skills, and the ability to manage multiple tasks efficiently.

Requirements

Strong understanding of managed care principles and insurance verification processes.
Knowledge of health insurance concepts (i.e., HMO, PPO, etc.).
Ability to multi-task, prioritize work, and make sound judgments.
Ability to remain patient during long periods of telephonic hold times.
Knowledge of all clinical systems that interface with our EHR/EMR and practice management system.
Skilled in Office Windows applications (Word, Excel, etc.).
Proficient in ICD-9/ICD-10 and CPT codes.
Ability to perform all tasks paying attention to detail.
Excellent customer service skills.
5+ years experience in insurance verification in a clinical setting.

Responsibilities

Verify insurance information using insurance portals and by contacting insurance companies.
Obtain authorization from managed care carriers for patient exams.
Contact primary care physician offices to obtain authorization or referral for office visits.
Contact patients when additional information is required.
Generate referrals in the EMR/EHR software referral module and link them to the appropriate visit and patient procedure upon obtaining authorization.
Perform other duties such as checking in patients or other assigned tasks.
Perform telephonic support for online authorization of routine services.
Provide direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activities.
Receive, track, and obtain insurance authorization from in-network and out-of-network insurance carriers.
Process pre-service authorizations for surgical procedures.
Review denials and follow up with providers to obtain medically necessary information to submit an appeal of the denial.
Resolve pre-certification denials and submit letters of medical necessity when needed.
Perform pre-certification for surgical procedures, including verifying deductible status and faxing clinical information to insurance companies.
Assist the billing department to obtain retro referrals for services rendered.
Explain benefits information to patients regarding their financial responsibility (co-pay, deductibles, etc.).