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Medical insurance and Authorization specialist
3 months ago
USA Clinics Group is looking for an organized and motivated individual to join the team as our newest Insurance Verification/ Prior Authorization Specialist This position performs the function of obtaining referrals, and/or authorizations prior to the service date for test, procedures, and admissions into the clinics.
Only candidates able to commute to the jobs on-site location (Northbrook, IL) Monday through Friday 5 days a week will be considered. Remote work is not an option.
- Reviews referring physician and patient documentation for Medical Necessity against insurance protocol requirements for pre-certification purposes.
- Actively communicates with staff regarding status of authorization. Communicates the need for reschedule and/or cancellation if authorization not in-hand).
- Directs liaison to offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements.
- Responsible for scheduling STAT, emergent patients for outpatient diagnostic exams.
- Interacts with patients, their representatives, physicians, physician office staff, and others to gather and ensure accuracy of demographic, billing and clinical information.
- Produces and distributes required forms with accurate patient information.
- Respects and protects the patient’s rights to confidentiality and privacy and discloses information only for the professional purposes which are in the patient’s best interests with full consideration of their legal rights.
- Displays a positive attitude when interacting with provider’s office staff, providers and fellow employees.
- Performs additional duties as assigned
Requirements
- High school graduate required. Advanced education preferred.
- At least 2 years of prior experience in a health care setting handling benefit verification and prior authorizations, required
- Strong computers skills and excellent typing skills; 50wpm
- Immaculate attention to detail and excellent proofreading skills
- Excellent Customer Service skills
- Strong data entry skills
- Excellent organizational skills
- Billing and Coding or other related certifications a big plus
INDH2
Benefits
- Health
- Vision
- Dental
- 401K
- PTO
