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Eligibility/Portal Auth Specialist
4 months ago
MINIMUM QUALIFICATIONS - Ability to perform essential duties as outlined below. Valid Drivers License OR Valid Photo ID Card High school Diploma or Equivalent Knowledge of health care insurance claim practices and compliance Knowledge of medical terminology, CPT and ICD-10 codes Knowledge of computers Ability to type and operate normal office equipment Ability to comprehend moderately complex instructions Ability to comply with Consumers Rights Ability to comply with Valleys and Division departmental safety procedures Ability to read, speak and write the English language _ PREFERRED QUALIFICATIONS - Knowledge of WV Medicaid policies and third party billing practices Strong working knowledge of Microsoft Excel. Capable of meeting deadlines for multiple tasks simultaneously Demonstrated problem solving and a strong attention to detail Experience in obtaining insurance eligibility and client authorizations _ ESSENTIAL DUTIES - Building consumer authorizations and effectively communicating with programs. Provide accurate and efficient computer entries for authorization requests. Verify member eligibility and benefits to facilitate appropriate procedures. Enter relevant data into systems accurately and promptly. Coordinate with programs to ensure timely and accurate information exchange. Handle authorization submissions and follow-ups for all insurance payors. Determine co-pays and/or benefits for services provided and communicates to appropriate party. Updates consumer insurance and demographic information as needed. Manages multiple authorization requests at once. Uses the Billing system to prepare third-party, invoice, and private pay billing. Uses EMR/PMS and insurance web portals accurately and efficiently. Assures that third-party, invoice, and private pay billing are submitted within the time frame of the Accounts Receivable closing schedule. Monitors outstanding claims and takes appropriate actions to follow up on past due receivables. Reviews billing/payment activity on consumer accounts for accuracy and makes necessary corrections. Monitors alternative payment options for consumers, as necessary. Maintains all documents in an organized manner. Effectively and professionally resolves issues with clients and insurance payers. Monitors, maintains, and uses appropriately, all equipment and supplies. Monitors all insurance types for regulations or submission requirements, changes, and communicate those changes to Revenue Cycle Manager with information required for Practice Management setup and Valley HealthCare System to be in compliance. Adheres to Valleys Values and Standards of Performance & Ethical Conduct.
