Insurance Authorization Specialist

Omega Healthcare Solutions•Boca Raton, FL

2d•$21 - $29•Remote

About The Position

Under limited supervision, the Insurance Authorization Specialist reviews and manages the benefits and authorizations for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in verifying benefits and obtaining authorizations for inpatient and outpatient services. The primary purpose or focus of the position is to obtain insurance eligibility, benefits, authorizations, pre-certifications and referrals for inpatient and outpatient, scheduled and non-scheduled visits. Updates demographic and insurance information in the system as needed. Serves as the primary documentation source for access and billing staff. Resolves accounts on work queues. Works with insurance companies to appeal denials. Interacts in a customer-focused and compassionate manner to ensure patients and their representatives' needs are met.

Requirements

Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing.
Minimum 1-2 years’ experience in Medical Billing/Coding and experience with standard office software products.
High School diploma or equivalent.
Previous customer service experience.
Experience interacting with patients and a working knowledge of third party payers.
Ability to perform a variety of tasks, often changing assignments on short notice.
Must be adept at multi-tasking
Will be required to learn and work with multiple software/hardware products (sometimes concurrently) during the course of an average work day
Must possess excellent communication skills, verbal and listening.
Must be able to maintain a professional demeanor in stressful situations.
Adept with machinery typically found in a business office environment.
Mathematical aptitude to make contractual calculations and estimate patient financial obligations.
Able to build productive relationships with all contacts.
Must be able to perform data entry with speed and accuracy
Use of usual and customary equipment used to perform essential functions of the position.

Nice To Haves

Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes is an added advantage.
Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation is an added advantage.
Two years of experience in a hospital patient access/patient accounts department, medical office/clinic or insurance company is desired.
Prior experience with verification, and payer benefit and eligibility systems is preferred.
Knowledge of Medical Terminology is preferred.
Knowledge of benefits and language is preferred.

Responsibilities

Maintain work queue assigned by the client
Verify benefits and secure auth for inpatient and outpatient services.
Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.
Obtains daily work from multiple work queues to identify what is required by CBO.
Work with providers to assure that CPT and ICD-10 code is correct for procedure ordered and is authorized when necessary.
Completes eligibility check and obtain benefits through electronic means or via phone contact with insurance carriers or other agencies and when necessary/requested provide initial clinical documentation.
Initiates pre-certification process with physicians, PHO sites or insurance companies and obtains pre-cert/authorization numbers and adds them to the electronic health record and other pertinent information that secures reimbursement of account.
Perform follow-up calls as needed until verification/pre-certification process is complete
Thoroughly documents information and actions in all appropriate computer systems
Notify and inform Utilization Review staff of authorization information to insure timely concurrent review
Validates or update insurance codes and priority for billing accuracy.
Works with insurance companies to obtain retroactive authorization when not obtained at time of service.
Works with insurance companies, providers, coders and case management to appeal denied claims.
Responsible for following EMTALA, HIPAA, payer and other regulations and standards.
Responsible for meeting daily productivity and quality standards associated with job requirements.
Adheres to department customer service standards.
Perform research to resolve customer problems
Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
Develop and implement prior authorization workflow to meet the needs of the customers.
Readily identifies work that needs to be performed and completes it without needing to be told.
Coordinates work to achieve maximum productivity and efficiencies
Monitors and responds timely to all inquiries and communications.
Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
Demonstrates ability to meet business needs of department with regular, reliable attendance.
Employee maintains current licenses and/or certifications required for the position.
Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
Completes all annual education and competency requirements within the calendar year.
Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.