Insurance Auth Spec

The Insurance and Authorization Specialist is responsible for obtaining benefits and eligibility information and submitting authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements. For Part-Time positions, the standard hours will be determined at hire with a minimum of 17.5 hours and maximum of 35 hours with potential week to week fluctuation if desired.

Job Responsibilities:

Run eligibility and benefits Call insurance to go through individual HCPCs and Policy Analyze paperwork to ensure that all required documentation has been received and that patient qualifies under the insurance guidelines Work with local center or directly with referring provider if additional documentation is needed Review paperwork for completion Request authorization and follow up on authorization Attach all documentation to the EMR system via a systematic naming process Input thorough notes in EMR system Communicate with the local center on authorization process Use critical thinking skills and payer knowledge to determine what dates to submit for authorization for existing patients needing authorization Work on getting paperwork for re-authorization 30-45 days before expiration Request authorizations 7-14 days before expiration, will receive report from Supervisor Assist in calling centers for missing information or corrections Answer phones and email questions from the centers Works on denials received Work with RBCO to determine denials and insurance issues Communicate professionally with patients, medical professionals, and co-workers Spend time getting eligibility and correct information on payers that require a more in-depth review

Requirements:

Read and analyze documents such as patient orders Comprehend pharmacy prescription terminology Effectively communicate with co-workers and patients alike Help with the training of employees Calculate figures and amounts in reference to frequency and doses dispensed Apply common sense understanding to carry out oral and written instructions

Education and Experience:

High school diploma or general education degree (GED), related experience and/or training, or equivalent combination of education and experience Medical billing/coding experience preferred Health insurance authorization submission experience preferred Computer entry experience necessary

Physical Demands:

The employee must occasionally lift and/or move up to 10 pounds.