Benefits/prior Authorizations Specialist

3 weeks ago

Fort Myers, United States Premier Women's Care of Southwest Florida Full time

Premier Women’s Care of Southwest Florida

OB/GYN Care Center FL 221

Benefits/Authorizations Verification Specialist
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- Job Title: Benefit/Prior Authorizations Verification Specialist (Non-Exempt Position)

General Summary of Duties: Contacts third party companies or utilizes web-based insurance resources to obtain plan benefits and authorizations for medical procedures, devices, and medications. Completes authorizations for a variety of procedures. Verifies coverage as plan dictates, deductible, coinsurance, co-pay, verification of in/out of network benefits and obtains prior authorization referral requests for HMO/PPO, commercial payers, Government plans (Medicare/Medicaid/Tricare), Medicare replacement plans and other third-party insurances. Conducts third party prior authorizations for medications.

Reports to: Billing Manager

Supervises: None

Typical Physical Demands:

- Requires prolonged sitting, some bending, stooping, and stretching.
- Requires hand-eye coordination and manual dexterity enough, operate a keyboard, copier/scanner, telephone, and other office related equipment.
- Requires normal range of hearing and eyesight and necessary to view and type on a computer screen for long periods of time and to prepare and communicate appropriate reports.
- Required ability to respond to difficult patient and medical insurance inquiries

OSHA Employee Exposure Classification: 3

Typical Working Conditions: Standard medical office working conditions. Involves frequent telephone communication with insurance companies, medication distributors, healthcare product suppliers, patients. Involves face-to-face communication with providers/provider staff as needed.

Example of Duties: (This list does not include all duties that may be assigned)
- Contacts primary and secondary insurance payers to collect insurance benefits, coverage, maximum benefits/deductibles and current use, authorization requirements, and other pertinent information
- Documents accurately in Athena for accurate diagnosis to obtain third party authorization.
- Responds to correspondence, phone calls, and patients in a courteous and timely manner.
- Able to review EHR for other assigned duties such as appointment type verification, closing OB episodes.
- Enters charges for a variety of in office procedures
- Notifies patients if authorizations, referrals, or co-payments are necessary.
- Maintains comprehensive supporting documentation and reports for insurances verified in designated files.
- Acts as a liaison between patient, physician office, and third parties to assist patient concerning financial responsibility.
- Answers telephone, screen calls, take messages and provides information for other assigned tasks as needed.
- Attends meetings as required.
- Performs other duties as assigned

Performance Requirements

Knowledge:

- Clinical documentation in Athena EHR, medical terminology as well as ICD-10 and CPT codes
- Strong understanding of insurance policies (HMO, PPO, Medicare, Medicaid, etc.)
- Grammar, spelling and punctuation to type information
- Medical office appointment types
- Third party vendor needs for information

Skill:

- Proper phone etiquette when contacting insurance carriers, patient, or physician’s offices for necessary information.

Ability:

- Acquire accurate benefit and eligibility information
- Read, understand, and follow written and verbal instruction
- Establish and maintain effective working relationship in a collaborative manner with patients, co-workers, and the public.
- To speak clearly and concisely

**Education**:
High School diploma or GED

**Experience**:
Two (2) years of work experience in the medical office environment

Computer literacy to include Electronic health record, word processing. Athena expereince desireable.

Certification/Licensure:
None required.

Alternative to Minimum Qualifications:
Additional appropriate education may be substituted for one year of work experience.

March 2019/revised July 2020/April 2024

**Benefits**:

- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift

**Education**:

- High school or equivalent (required)

**Experience**:

- benefits verification: 1 year (required)
- Customer service: 2 years (preferred)

**Location**:

- Fort Myers, FL (required)

Work Location: Remote

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