Eligibility and Authorization Specialist

4 weeks ago

Pasadena, United States GrandCare Health Services Full time

GrandCare Health Services is a physician-trusted leader in post-surgical rehabilitation delivered in the comfort of patients’ own homes. We are recognized by the Centers for Medicare and Medicaid Services as a 5-Star agency, placing us in the top 10% nationally. Our experienced clinicians collaborate closely with patients’ physicians to develop a personalized plan of care specific to patient needs Our tailored, concierge approach is proven to promote faster healing, reduce stress and anxiety, and get patients moving again. GrandCare employees can be proud to know that their work is meaningful and dramatically changes lives for the better. This position is an outstanding launching point for people with solid customer service, phone line skills, and tech skills to move up in the medical administrative professional world. As a Medical Administrative Assistant here is what you may expect:

Job Summary:

Under the direction of the Clinical Supervisor, the Eligibility and Authorization Specialist will be responsible for ensuring that payers are prepared to reimburse GrandCare for scheduled services in accordance with the payer-provider contract. Typical duties include contacting payers to request service authorization and collecting financial and/or demographic information from patients.

Essential Functions:

Unless specifically required by law, rule, regulation, or local ordinance, all job attributes are preferred. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Obtain prior authorizations from third-party payers in accordance with payer requirements.

Remain current on all regulations, policies and procedures and process changes that are essential to completing assigned daily tasks.

Verify patient's insurance and benefits information.

Performs any written and/or verbal communication necessary to exchange information with designated contacts.

Comply with HIPAA regulations, as well as Company policies and procedures regarding patient privacy and confidentiality.

Work with other departments to gather the clinical information required by the payer to authorize services.

Work with other departments to support appeal efforts for authorization-related denials.

Maintain accurate records of authorizations within the EMR.

Contact patients to gather demographic and insurance information as needed, and update patient information within the EMR.

Identify patients who will need to receive Medicare Advance Beneficiary Notices of noncoverage (ABNs).

Perform other registration duties as required.

Required Education, Experience & Professional Skills:

Associate degree in Business Administration or Healthcare-related field, preferred OR 3 years of related work experience

1 year of experience with medical terminology and healthcare insurance processes, home health preferred

Excellent communication and customer service skills

Proficiency in the use of healthcare information systems

Ability to prioritize and multitask

Ability to maintain professional tone at all times when communicating with patients and payer representatives

Critical problem solving skills

Experience within financial clearance setting

Strong attention to detail

Experience with MS Office Suite, including Word, Excel, PowerPoint, Outlook, and Teams #J-18808-Ljbffr

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