Insurance Authorization Specialist

4 weeks ago

Glendale, United States Palo Verde Hematology Oncology LTD Full time

Description:
Position Summary: This position is responsible for obtaining benefits and prior authorizations for scheduled treatments/procedures. Responsible for educating patient on insurance coverage and benefits. Assess patients’ financial ability; may educate patient on assistance programs.

Essential

**Responsibilities**:
The essential functions include, but are not limited to the following:

- Prior to a patient receiving treatment; obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
- Responsible for acquiring and documenting all Prior Authorizations need for patients before first visit.
- Assess patients’ ability to meet expenses and discusses payment arrangements.
- May educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms.
- Based upon diagnosis, estimated insurance coverage, and financial assistance, completes Patient Cost Estimate form.
- Completes appropriate reimbursement and liability forms for patient’s review and signature. Forwards appropriate information and forms to billing office.
- Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
- Review patient account balance and notify front desk of patients to meet with
- Ensure that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately
- At each patient visit, verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs).
- Stays current on available financial aid. Develops professional relationships with financial aid providers. Networks with financial aid providers to obtain leads to other aid programs.
- Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records.
- Maintains updated manuals, logs, forms, and documentation.
- Other duties as requested or assigned.

**Requirements**:
Qualification/Requirement:

- Excellent computer skills. Must be able to work effectively with common office software and medical records software.
- Requires the ability to perform basic math functions and to assemble data into reports using spreadsheet programs.
- Must have the ability to handle confidential information and sensitive issues.
- Must be able to work under mínimal supervision and make independent decisions using good judgment.
- Requires excellent communication, human relations, attention to detail and organizational skills.
- Requires the ability to multi-task activities.
- Must be able to communicate effectively to various ethnic and cultural backgrounds obtaining necessary resources when language barriers present.
- Requires the ability to perform efficiently with some analytical/problem solving skills.
- Ability to deal with problems involving occasional, last-minute changes in generally standardized situations.

Education/Training/Experience:

- High school diploma or a GED.
- Six months related experience and / or training.
- Knowledge of EMR, medical terminology, ICD-10 and CPT codes.

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