Benefit Authorization Specialist
3 weeks ago
The Benefit Authorization/Verification Specialist plays a crucial role in ensuring seamless benefit verification, negotiation, and pre-authorization processing for contracted payors, group health, Medicare, managed care, workers' compensation, personal injury, and governmental payor patient referrals. This position requires a strong understanding of corporate policy and procedure, as well as the ability to apply specialized knowledge to modify existing methods, solve problems, and complete tasks.
Key Responsibilities- Process new orders promptly, ensuring timely completion of tasks within the designated timeframe.
- Review and confirm documentation to ensure compliance with company guidelines and payor standards for medical necessity.
- Verify insurance benefits and initiate prior authorization when necessary, maintaining effective communication with adjustors and patients.
- Maintain positive patient relationships through professional communication, effective management of expectations, and timely resolution of issues.
- Initiate patient communication, providing clear information on authorization, benefits, co-pays, and timelines.
- Provide product information, emphasizing features, pricing, and payment options, as well as explaining insurance coverage for third-party reimbursement.
- Coordinate payment plans, assisting patients with specialized co-payments, deductibles, and payment arrangements.
- Stay updated on industry changes, implement process improvements, and meet department and company goals efficiently.
- Maintain ethical behavior and professionalism, adhering to company policies and handling communications diplomatically.
- High School Diploma/GED
- Associate's Degree-preferred
- Additional 2+ years related experience or equivalent of education plus directly related education, training, and experience
- 2+ years experience processing orders in a healthcare workplace environment
- 2+ years experience conducting insurance verifications
- Solid understanding of insurance Explanations of Benefits (EOB's)
- Highly proficient in software such as Word, Excel, PowerPoint, and other standard MS Office Programs
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, decimals, and percentages
- Preferred Bi-Lingual Spanish
VQ Orthocare is an Equal Opportunity Employer, committed to providing a diverse and inclusive work environment. The work environment varies between a typical office setting and patient home environments for short durations. Reasonable accommodations may be provided to allow qualified individuals with disabilities to perform the essential duties and tasks.
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