Position Summary 

Our Verification/ Authorization Associates are responsible for verifying active insurance coverage, obtaining all necessary facility and specimen collection information to bill in accordance to CMS regulations as well as contacting insurance companies to secure preauthorization required for patients to receive our services and contacting facilities for Medical Records when necessary. We need individuals to ensure information obtained is complete and accurate, follow up on requests, and apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements   

Job Responsibilities 

• Adheres to all company policies and procedures. 

• Review all patient insurance information needed to complete coverage verification.   

• Verifies insurance eligibility to ensure claims are billed accurately and in accordance to payer guidelines. 

• Ensures timely and accurate insurance authorizations are in place prior to services being rendered. 

• Responsible for prior authorization submissions and management. 

• Maintains compliance with HIPAA and other healthcare regulations  

• Obtains medical records from facilities when necessary 

• Provides all information to the payer including medical record information and/or letter of medical necessity for determination of benefits. 

Required Qualifications 

• High School degree or equivalent required. 

• 6+ Months experience in medical office setting 

• Proficient in MS Office (Word, Excel, Outlook) 

• Must be highly organized with a strong attention to detail 

• Demonstrates solid time management skills and organization 

• Flexibility and ability to handle and manage frequent changes effectively and efficiently 

• Basic knowledge of insurance processing, guidelines and general laws related to all payers. 

• Basic knowledge of clinical documentation review for alignment with insurance authorization requirements 

• Basic knowledge of CPT, ICD-10 

• Meets productivity/performance standards as set forth by management. 

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Preferred Qualifications 

• Prior experience working with Insurance providers in a payor setting.  

• Must possess professionalism, superior organizational skills, communications skills that allow the ability to educate and influence, an unrelenting passion for persistent follow up, and a drive towards problem resolution.  

• Drive for Results (Service, Quality, and Continuous Improvement) – Ensure procedures and processes are in place that will lead to delivery of quality results and continually reassess their effectiveness to achieve continuous improvement. 

• Communication – Proficient verbal and written communication skills. Willingness to share and receive information and ideas from all levels of the organization to achieve the desired results. 

• Teamwork – Commitment to the successful achievement of team and organizational goals through a desire to participate with and help other members of the team. 

• Customer Service Focus – Demonstrate a focus on listening to and understanding client/customer needs and then delighting the client/customer by exceeding service and quality expectations. 

Physical Demands 

• Must possess ability to sit and/or stand for long periods of time. 

• Must possess ability to perform repetitive motion. 

• Ability to lift up to 15 pounds. 

• The majority of work is performed in a desk/cubicle environment. 

Training 

• All job specific, safety, and compliance training are assigned based on the job functions associated with this employee.  

Other  

• Willingness to work shift work and overtime. 

• Job may require occasional weekends, evenings, and/or holidays.