RCM/OPH Insurance Authorization Specialist

Eye Care Partners Career Opportunities•Overland Park, KS

5d•Hybrid

About The Position

The Intake Specialist – Insurance Authorization is responsible for timely, accurate and comprehensive review of patient schedules. Coordinates and effectively communicates with appropriate personnel regarding insurance carriers, business office services to ensure quality patient care and appropriate reimbursement. Also obtains the appropriate Pre-Authorization and Referral information, including verification of patient insurance, from physician offices and insurance carriers.

Requirements

High School Diploma or GED
2+ years' experience medical authorizations
Comprehensive understanding of insurance verification, contract benefits and medical terminology
Ability to enter data into various electronic systems while maintaining the integrity and accuracy of the data
Ability to function effectively under stress of conflicting demands on time and attention, while successfully meeting deadlines
Excellent organization, time management, and prioritization skills
Professional in appearance and actions
Logical and Critical thinking skills
Enjoys learning new technologies and systems
Detail oriented, professional attitude, reliable
Exhibits a positive attitude and is flexible in accepting work assignments and priorities
Meets attendance and tardiness expectations
Management and organizational skills to support the leadership of this function
Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
Interpersonal skills to support customer service, functional, and teammate support need
Able to communicate effectively in English, both verbally and in writing
Ability to clearly articulate a response using appropriate voice modulation
Ability to maintain control of a call de-escalating issues and instilling confidence that a resolution will be found
Ability for basic to intermediate problem solving, including mathematics
Basic to intermediate computer operation
Proficiency with Microsoft Excel, Word, PowerPoint and Outlook
Specialty knowledge of systems relating to job function
Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Responsibilities

File requests for prior authorization for all insurances that require based upon plan or insurance contract
Request, obtain, and document all prior authorizations (or denials of same) appropriately and in a timely manner
Obtain information about patient insurance coverage, benefits and eligibility
Maintain and update internal listing of insurance carriers that require authorization
Run system-generated reports to verify procedures by insurances requiring authorization are being captured
Assist collection team with obtaining retro authorizations
Coordinate with Call Center and Optical Offices on prior authorization and patient billing activity
Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
Performs other duties that may be necessary or in the best interest of the organization.