Job Description

The Insurance and Authorization Specialist is responsible for obtaining benefits and eligibility information and submitting authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements. For Part-Time positions, the standard hours will be determined at hire with a minimum of 17.5 hours and maximum of 35 hours with potential week to week fluctuation if desired.

Job Responsibilities:

• Run eligibility and benefits
• Call insurance to go through individual HCPCs and Policy
• Analyze paperwork to ensure that all required documentation has been received and that patient qualifies under the insurance guidelines
• Work with local center or directly with referring provider if additional documentation is needed
• Review paperwork for completion
• Request authorization and follow up on authorization
• Attach all documentation to the EMR system via a systematic naming process
• Input thorough notes in EMR system
• Communicate with the local center on authorization process
• Use critical thinking skills and payer knowledge to determine what dates to submit for authorization for existing patients needing authorization
• Work on getting paperwork for re-authorization 30-45 days before expiration
• Request authorizations 7-14 days before expiration, will receive report from Supervisor
• Assist in calling centers for missing information or corrections
• Answer phones and email questions from the centers
• Works on denials received
• Work with RBCO to determine denials and insurance issues
• Communicate professionally with patients, medical professionals, and co-workers
• Spend time getting eligibility and correct information on payers that require a more in-depth review

Qualifications

• Read and analyze documents such as patient orders
• Comprehend pharmacy prescription terminology
• Effectively communicate with co-workers and patients alike
• Help with the training of employees
• Calculate figures and amounts in reference to frequency and doses dispensed
• Apply common sense understanding to carry out oral and written instructions

Education and Experience:

• High school diploma or general education degree (GED), related experience and/or training, or equivalent combination of education and experience
• Medical billing/coding experience preferred
• Health insurance authorization submission experience preferred
• Computer entry experience necessary

Physical Demands:

The employee must occasionally lift and/or move up to 10 pounds.