Find & Apply For Enrollment / Eligibility Specialist Jobs in Puyallup, Washington

Company Overview Northwest Medical Specialties is dedicated to providing compassionate, high-quality healthcare across multiple clinics. Our organization values a caring atmosphere and is committed to fostering a diverse and inclusive workforce that prioritizes patient well-being and community engagement. Job Overview The Authorization Coordinator is responsible for the utilization review of treatment and drugs that are administered at all NWMS locations. This position will initiate and coordinate pre-certification and prior authorization for patients with their insurance carrier.

Essential Duties and Responsibilities :

Performs Insurance Benefit reviews for patients that have new treatment ordered and patients currently on treatment who have had a change of insurance. Re-verifies insurance daily, monthly or quarterly depending on the type of treatment and insurance plan. Maintains updated notes in Allscripts PM with patients remaining out of pocket. Reviews chemotherapy/infusion schedules daily and updates status of the Business office on the flow sheet. Submits Authorization/Pre-determination requests for treatment to insurance companies. Performs Utilization reviews for all new treatment ordered and any treatment changes to ensure medical criteria is met (FDA, NCCN, Payor specific medical policy). Obtains stat authorizations for any urgent add-on requests. Maintains accurate authorization information in Allscripts PM and ONCOEMR. Communicates with providers/nursing staff of any insurance restrictions or payer specific requirements. Performs financial reviews and calculates patient responsibility for infusion/treatment and forwards to the financial counselors. Provides any information requested regarding treatments to physicians, nurses, and billing staff, as needed. Obtains HMO/ Out of network office visit referrals as required by Insurer, dependent upon the plan coverage for all patients Researches and corrects invalid or incorrect patient insurance demographic information to ensure proper billing and maintain accuracy of authorization notes in Allscripts PM that correlate with any insurance changes. Works closely with business office and drug representatives to ensure HCPCS codes, ICD10 codes, and procedure codes are accurate. Assists patients with questions or concerns regarding their insurance plan. Works with and assists the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested. Responds professionally to all inquiries from patients, staff, and payors in a timely manner, usually within 24 hours. Keeps management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding. Accurately documents patient accounts of all actions taken. Establishes and maintains a professional relationship with all staff in order to resolve problems and increase knowledge of account management. Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements. Educates clinic management and staff regarding changes to insurance and regulatory requirements. Informs management of any billing or authorization concerns, backlogs, insurance issues, problem accounts and time available for additional tasks. Negotiates a work improvement plan with management to raise work quality and quantity to standards, as necessary. Attends appropriate workshops to enhance clerical, billing and computer skills. Completes additional projects and duties as assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Comprehensive working knowledge of third-party insurance processes required. Overall knowledge of authorization, benefits, referral requirements and claims processing for insurance companies and plans both private and government. Understanding of clinic operations related to patient registration, insurance, referrals, and authorizations. Knowledge of WA state Health Exchange plans and managed care plans. Understanding of insurance payor reimbursement, authorization, collection practices, and practice management systems helpful. Ability to adapt to change, prioritize tasks, and assess and resolves problems effectively Strong interpersonal skills and ability to communicate effectively in written and spoken English. Demonstrates the ability to carry out assignments independently, work form procedures, and exercise good judgment. Demonstrates the ability to maintain the confidentiality of all records. Ability to manage multiple tasks and demands given tight time constraints while ensuring a high degree of accuracy and attention to detail. Regular and punctual attendance. Education/Experience

• High School diploma or GED; Two years of College or Professional School preferred
• One year of experience with ICD-10, CPT, and HCPCS codes.
• One year of experience working in a multispecialty group practice or healthcare system preferred.
• One year of third-party eligibility verification experience on an automated patient accounts system, including experience with insurance referrals/authorizations preferred.
• Training or education in office and personnel management, computer/database systems and practice management systems.

Pay:

$25.00 - $30.00 per hour

Benefits:

401(k) Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Puyallup, WA 98373