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Insurance Eligibility Specialist

2 months ago

Greenville, South Carolina, United States Crossroads Treatment Center Full time
Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Crossroads is a premier provider of outpatient medication-assisted treatment (MAT) for individuals facing addiction challenges. Our focus is on assisting patients with opioid use disorder (OUD) through the use of medications such as methadone and buprenorphine. Since our inception in 2005, we have remained dedicated to supporting our patients' journeys toward recovery from substance use disorders, expanding to over 100 clinics across nine states. As an equal opportunity employer, we value diversity and strive to foster an inclusive atmosphere for all employees and patients.

Role Overview of a Verification and Authorization Specialist
  • Conducting benefit verifications for patients during intake, as well as through daily/monthly batches and individual requests, addressing any issues related to ineligibility or coordination of benefits.
  • Researching and processing eligibility inquiries in accordance with business regulations, internal standards, and processing protocols. Assessing the necessity for prior authorizations or retro billing.
  • Collaborating with internal departments to implement changes in payer billing guidelines, updating patient identification, other health insurance details, provider identification, and related files as needed.
  • Overseeing the enrollment and eligibility processes for our clients prior to submission to payers.
  • Understanding and adhering to state and federal regulations, along with system policies regarding compliance, integrity, and ethical billing practices.
  • Possessing a solid understanding of payer eligibility guidelines, payer portals, and clearinghouses to ensure comprehensive verification of benefits.
  • Responsible for verifying patient insurance benefits in alignment with departmental objectives and insurance guidelines.
  • Comprehending and complying with the rules surrounding Coordination of Benefits.
  • Addressing all eligibility-related denials to identify trends aimed at enhancing clean claim rates.
  • Generating multiple daily reports on productivity indicators using various reporting tools.
  • Ensuring all referrals are processed within a 24/48-hour turnaround time from receipt.
  • Completing and maintaining base training requirements.
  • Performing other assigned duties as necessary.
Education and Experience Requirements
  • A minimum of 2 years of experience in electronic insurance verification, real-time eligibility, and/or billing within a hospital or physician office environment.
  • General knowledge of HCPCS, CPT-4, and ICD9-10 coding and/or medical terminology.
  • Familiarity with various payer requirements and regulations for benefit utilization.
Work Hours and Schedule
  • This position will initially require full in-office attendance during the training period, which may vary based on the candidate's ability to meet competency standards. Upon meeting these requirements, the employee may transition to a schedule of three days in the office and two days remote.
Benefits Package
  • Medical, Dental, and Vision Insurance
  • Paid Time Off (PTO)
  • A variety of 401K options, including a matching program with no vesting period
  • Annual Continuing Education Allowance in a related field
  • Life Insurance
  • Short/Long Term Disability
  • Paid maternity/paternity leave
  • Mental Health Day
  • Calm subscription available for all employees