Insurance Specialist – Prior Authorization
Location
Ohio
Posted
5 days ago
Salary
$18 - $21 / hour
Seniority
Mid Level
Job Description
Insurance Specialist – Prior Authorization
Meduit | Driving Revenue Cycle Performance
• Reduce outstanding accounts receivable by managing claims inventory • Speak to patients and insurance companies in a professional manner regarding their outstanding balances • Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. both in-person and by telephone to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility (insurance, public programs, etc.), determine financial responsibility and/or to identify sources of payment for services • Request, input, verify, and modify patient’s demographic, primary care provider, and payor information • Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc. • Answer questions by phone and provide quotes for services; identify financial resources, etc. in accordance with the client policies and procedures • Utilize various databases and specialized computer software for revenue cycle activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts, etc. • Explain charges, answer questions, and communicate a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies • Work with Claims and Collections in order to assist patients and their families with billing and payment activities
Job Requirements
- High School Diploma/GED
- 2+ years of Denials Management experience
- 2+ years Medical Billing/Follow-up experience
- Medicare, Medicaid, and commercial payor experience
- Experience with Workers Comp Pre-Access
- Proficiency with PC-based applications (Microsoft Outlook, Word, and Excel)
- Download speed of 30MB or higher & upload speed of 10MB or higher are REQUIRED.
- Access to a Secure and Private workspace (a space in which no one can hear or see you as you may have protected health information on your screen or you may say names, social security numbers or other PHI)
- Employment eligibility: Must be legally authorized to work in the United States without sponsorship
- As a condition of employment, a pre-employment background check will be conducted
Benefits
- Comprehensive paid training
- Medical, dental, and vision insurance
- HSA and FSA available
- 401(k) with company match
- Paid Wellness Time and Holidays
- Employer paid life insurance and long-term disability
- Internal growth opportunities
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Role Description Make an impact in patient care—behind the scenes. Regional Cancer Care Associates (RCCA) is seeking a detail-oriented and motivated Insurance Specialist to join our growing team. In this vital role, you will help ensure patients receive the care they need by supporting accurate billing, timely payments, and exceptional service. Employment Type: Full Time Location: Teaneck, NJ (Remote) Compensation: $18.99 - $29.22 hour Compensation packages based on your unique skills, experience, and qualifications. Responsibilities - Monitors delinquent accounts and performs collection duties. - Reviews reports, identifies denied claims, researches and resolves issues, may perform a detailed reconciliation of accounts, and resubmits claim to payer. - Reviews payment postings for accuracy and to ensure account balances are current. - Works with co-workers to resolve payment and billing errors. - Monitors and updates delinquent accounts status. - Recommends accounts for collection or write-off. - Verifies existing patients have necessary referral and/or authorization documentation prior to examination date. - Contacts and follows up with patient’s physician for any missing or incomplete documentation. - Contacts patients to secure past due balances, verifies patient demographics and insurance providers, updates information in systems, and documents conversations. - Answers patient payment, billing, and insurance questions and resolves complaints. - May refer patients to Patient Benefits Representative to set up payment plans. - Contacts third party payors to resolve payor issues, expedite claim processing, and maximize medical claim reimbursement. - Maintains credit balances of patients and payors ensuring timely refunds within government guidelines/regulations. - Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records. - Performs other duties as requested or assigned. Qualifications - High School diploma or equivalent required. - Minimum four (4) years combined medical billing and payment experience required. - Demonstrate knowledge of medical coding, preferably oncology coding. - Demonstrate knowledge of state, federal, and third party claims processing required. - Demonstrate knowledge of state & federal collections guidelines. - Must successfully complete required e-learning courses within 90 days of occupying position. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The position requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. The position requires standing and walking for extensive periods of time. The employee occasionally lifts and carries items weighing up to 40 lbs. The position requires corrected vision and hearing to normal range. Work Environment The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. Benefits - Health, dental, and vision plans. - Wellness program. - Health savings account - Flexible spending accounts. - 401(k) retirement plan. - Life insurance. - Short-term disability insurance. - Long-term disability insurance. - Employee Assistance Program (EAP). - Paid Time Off (PTO) and holiday pay. - Tuition discounts with numerous universities.



