Insurance Verification & Authorization Agent

Optimus Health Care•Stratford, CT

About The Position

Optimus Health Care is seeking a full-time Insurance Verification & Authorization Agent for its Stratford, Connecticut location. The role is part of the behavioral health care team and works with providers, nurses, and clinical support staff to ensure insurance verification and authorization processes are complete and timely. The agent performs pre-arrival work by verifying patient demographic and insurance information to support prompt payment for services. The position contacts insurers to verify coverage and helps patients understand their benefits, while ensuring authorization for specialty services and office visits. The agent may serve as a liaison among patients, providers, behavioral health providers, and other parties involved in a plan of care, and appropriately links referrals to identified visits. The role includes reviewing schedules and verifying coverage, copays, deductibles, coordination of benefits, and pre-authorization requirements. It also requires documenting relevant insurance changes and concerns in the patient system, communicating coverage concerns to patients, referring eligible patients for entitlement assistance, and supporting the Practice Manager with projects, including billing-related performance improvement initiatives. Flexibility to work at other Optimus Health Care sites may be required.

Requirements

High school diploma or GED.
Great computer skills.
Commitment to maintaining patient privacy.
Flexibility to work at other Optimus Health Care sites as necessary.

Nice To Haves

Associate degree preferred.
Five years of experience preferred, preferably in a health care setting.
Familiarity with electronic medical records (EMR) is helpful.
Bilingual skills are helpful.

Responsibilities

Verify insurance information to support billing of services.
Review appointment schedules and identify insurance plans requiring verification.
Verify insurance coverage, copays, deductibles, amounts met to date, and pre-authorization requirements through employers, insurance carriers, or online verification.
Verify coordination of benefits using the birthday rule when the patient is a minor.
Update patient notes in the system with pertinent insurance changes or concerns to maintain account history for relevant departments.
Assist the Practice Manager with related special projects, including billing participation in performance improvement initiatives.
Refer patients who qualify for entitlement to FCC by task.
Communicate insurance coverage concerns and any additional information required by the carrier to patients.
Ensure patients are authorized for specialty services and office visits.
Appropriately link referrals for identified visits.
Act as a liaison among patients, providers, referring providers, behavioral health providers, and other parties involved in the plan of care, as needed.
Perform other related duties as required.