Authorization Specialist (must be local to Tampa Bay area)
GENERAL SUMMARY:
This is a work from home role. Employees who are trusted to work from home must comply with all requirements of monitoring their hours and productivity.
The Authorization Specialist verifies benefits and eligibility for care in the outpatient setting including insurance pre-authorization if indicated. Communicates with the patient, eligibility, co-pay amounts, out of pocket expenses and facilitates payment plan options if necessary. This process assures bills for services will be paid promptly. Ensures efficient operation and effective reimbursement of third party account receivables. Researches accounts, corrects provider coding as needed, abstracts information from medical chart and refiles or appeals claims denied for coding-related reasons. Submits additional medical documentation and tracks account status.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
- Initiates insurance verification process and completes the authorization in established time frames. Provides accurate information to insurance provider.
- Assures hospital, outpatient center and physicians are network participating providers. If out of network, patients and physician are informed.
- Assures prescription from referring physician is present to obtain coverage authorization from insurance provider.
- Works diligently to meet established time lines of 24 hour turn around.
- Requests authorization from insurance company case manager to provide specific services and parameters of care, e.g. hyperbaric medicine.
- Creates follow-up system to assure on-going authorizations are obtained.
- Accurately enters data into software programs.
- Maintains positive working relationship with provider and payer.
- Actively participate in departmental performance improvement process.
- Assist with patient pre-registration when appropriate.
- Processes 3rd party account receivables, ensuring efficient operation and effective reimbursement.
- Researches accounts, corrects provider coding as needed, abstracts information from medical chart, and refiles or appeals claims denied for coding-related reasons as needed.
- Resubmits additional medical documentation and tracks account status as needed.
- Monitors and analyzes unresolved 3rd party accounts as assigned.
- Possesses strong verbal communication skills; demonstrating ability to communicate with all age groups.
- Ability to work independently from home and comply with any remote work established practices.
- Ability to work closely with physicians; problem solving skills.
- Knowledge of medical terminology.
- Knowledge of Microsoft Word and Excel.
- Ability to communicate and work closely with others.
- Knowledge of confidentiality standards.
- Knowledge of ICD10 medical coding and hospital outpatient services.
- Minimum 2 years of medical insurance verification experience.
- Minimum 3 years of experience in health care billing and collection.
- Knowledge of secondary or supplemental insurance claim filing (COB).
Job Type: Full-time
Pay: Up to $17.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
- Overtime
Application Question(s):
- are you local to the Tampa Bay area
Education:
- High school or equivalent (Preferred)
Experience:
- Insurance verification/authorization: 2 years (Required)
- Medical terminology: 1 year (Preferred)
Work Location: Remote
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