Insurance Verification – Authorization Specialist
InfuSystem
full-time
Posted on:
Location Type: Hybrid
Location: Rochester Hills • Missouri • United States
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About the role
- 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.
- Responsibilities include 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.
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
Benefits
- Health plan options that include an employer contribution
- Health Savings Account (HSA)
- Healthcare and Dependent Care Flexible Spending Accounts (FSA)
- Dental and Vision premiums covered by InfuSystem
- Life Insurance, STD & LTD
- Paid Parental Leave
- Adoption and Fertility Assistance
- 401(k) with a specified Company Match
- Employee Stock Purchase Program
- Tuition Assistance
- Generous Paid Time Off plan
- Employee Assistance Program
- Competitive Pay
- Employee Referral Bonus
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
patient eligibility verificationbenefit information interpretationauthorization processinginsurance terminologydocumentationclaims processingmedical necessity certificationdata entrybilling accuracy
Soft Skills
organizational skillstroubleshooting skillsteamworkdeadline managementattention to detailmotivation
Certifications
Associate degree