Insurance Verification / Authorization Specialist

InfuSystem•Rochester Hills, MI

17h

About The Position

The Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information. The Specialist will interpret benefit information and is familiar with insurance terminology to identify and document the correct plan. This position will request authorizations on payer websites, through fax submissions or over the phone and is responsible for follow-up, documentation, and re-authorizations as necessary.

Requirements

Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.
Organizational skills
Medical terminology
Good troubleshooting skills
Ability to work as a team
Ability to independently meet tight deadlines in a project-based atmosphere
Follows department processes and procedures
Highly motivated and detail-oriented
Strong work ethic
Sound judgment
Proven written and verbal communication skills
Natural curiosity to pursue issues and increase expertise
Pursue and design innovative analytical performance metrics
The courage to promote and defend ideas and analyses
Passionate about InfuSystem and serving customers and patients
Strives to make an impact on improving our business processes and results
Exemplary honesty and integrity
Ability to collaborate effectively and work selflessly as part of a team

Responsibilities

Initiating, following up, and securing authorizations sent to third-party payors
Track and follow up on all pending authorizations within 7 – 14 days depending upon payer guidelines to expedite the claims process.
Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patients
Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in place
Work closely with customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timely
Verify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems
Organize work to avoid lost revenue due to filing limitations
Review and verify all insurance plans and confirm patient's eligibility and benefits specific to DME.
Review and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented in HDMS / OnBase.
Input the correct Payer Plan ID# and enter data into systems to ensure accurate billing for current and future services.
Determine the extent of liability for insurance plans, coordination of benefits, and personal responsibility.
Other duties as assigned.