Insurance Eligibility Specialist

EXCELSIOR ORTHOPAEDICS GROUP • Eggertsville, NY

5d • $17 - $30 • Onsite

About The Position

Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriate system. Your knowledge of insurance carriers and specific plan details will make you a valuable resource to patients, providers, and coworkers! Knowledge of medical codes and medical terminology required.

Requirements

• High school degree or equivalent.
• Medical terminology required.
• Ability to prioritize and perform multiple tasks with many interruptions.
• EMR experience required; MEDENT preferred.

Nice To Haves

• Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.
• EMR experience required; MEDENT preferred.

Responsibilities

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.
• Obtains verification/eligibility for specific service.
• Research, handle, and make determination regarding insurance verification escalation issues and/or discrepancies.
• Audit, track, and trend insurance data entry error, communicate and provide feedback and training as needed.
• Verifies physician orders are accurate.
• Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.
• Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.
• Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.
• Helps to maintain a professional atmosphere for patients, family members and staff.
• Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
• Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.
• Liaison with other departments for process improvements.
• Handle other projects as assigned.

Benefits

• We offer a comprehensive benefits package that includes health (with employer contribution), dental, and vision insurance, employer paid base life, and other voluntary benefits.
• Time off benefits include paid combined time off (CTO) and seven paid holidays, plus a floating holiday after one year of service.
• Retirement benefits include a 401(k) with company contribution and profit sharing after one year of service.
• Qualified team members become eligible to participate in medical benefits on the 1st of the month following date of hire, and retirement benefits after 90 days.
• We also provide professional development opportunities, flexible work schedules, wellness incentives, healthy vending options, and relaxed dress code on Fridays.
• Our community-focused culture encourages participation in local events, fundraisers, and causes chosen by our team.
• We are committed to providing our employees with the resources they need to thrive both personally and professionally.
• Other voluntary benefits include Voluntary Short Term Disability, Long Term Disability, Critical Illness, Accident Insurance, Supplemental Life Insurance, and legal and identity protection and pet insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees