Eligibility and Authorization Specialist

1 month ago


Los Angeles, United States Regroup Full time

Responsibilities

This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations.

Determines deductibles, copayments, coinsurance, CPT and Diagnosis/Procedure Codes, Medical policies, LCD s and Medical terminology.

Reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization.

Provide patient education of service benefits, status of pending or denied authorizations and for limited benefit coverage.

Accurately enters insurance benefits and authorization information into patient accounts.

Effectively working with insurance companies, with extensive amount of time on the telephone.

Provide timely responses to voicemail and email inquiries to the verification team.

Provide feedback to staff of patient benefits/authorization in a timely manner.

Assist with submission appeals and follow up with unpaid claims.

Create patients’ statements.

Performs other duties as assigned.

Qualifications

We are looking for an individual with at least 1 year of knowledge and experience in Insurance benefits verification, Authorization requests, and referral requests for Medicare, PPO, HMO, and IPA insurances.

Positive, caring attitude, and self-motivated to do whatever is necessary to provide.

Outstanding patient service and do whatever is needed to ensure effective operations.

Basic level skill in Microsoft Excel, Word, and outlook.

Can multitask, prioritize, and manage time effectively.

Have Impeccable attention to detail.

Enjoys working both independently and collaboratively as part of a team.

Open to learn and improve skills.

High school diploma is required.

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