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

• • 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.