November 7, 2024

Choice Health At Home

Tyler

FULL TIME

Benefits & Authorizations Clerk

Job Summary
The primary function of the Benefits & Authorization Specialist is verifying prospective patient’s insurance coverage and benefits, educating the company intake and billing teams of patient benefit information, obtaining pre-authorization for services from insurance payors, following up on authorization for service requests with payors, obtaining retroactive authorizations for services with payors, and maintaining authorizations for all new and existing patients until patient discharge occurs.

Job Qualifications
Education: High School Graduate (College Preferred).

Experience: One-year insurance verification and/or authorization experience strongly preferred.

Skills: Knowledge of medical terminology, intermediate computer skills, and attention to detail. Good interpersonal skills and an ability to establish and maintain effective working relationships with all segments of the staff.

Transportation: Reliable transportation. Valid and current auto liability insurance.

Environmental/Working Conditions: Performs duties either remotely or in an office environment during the Company’s operating hours (8:00am – 5:00pm). If remote, must have reliable high-speed internet access, and a working cell phone or landline (technology not reimbursed by company). Works in a routine office environment; noise level may be moderately high. Must have the ability to work during business hours and occasional extended hours as needed and requested by the manager.

Receives and appropriately verifies new referrals’ insurance benefits and authorization requirement in a timely manner.

Provide verified information to intake/clinical tram and Revenue Cycle Manager.

Requests authorization from payers, follow up on authorization request, manage and maintain authorization for all new and existing patients.

Provides effective communication to appropriate staff members, billing specialist, and Revenue Cycle Manager of changes to insurance coverage and or authorization for existing patient.

Uploads payor communication documents into the EMR, as needed, utilizing company guidelines for document naming conventions and attachment types.

Monitor and maintain assigned workflow.

Responds to company and billing team needs in a professional and timely manner.

Demonstrates commitment, professional growth, and competency.

Participates in Company sponsored in-service training.

Promotes the company culture, values, and mission by presenting a positive image to those we serve, including patients, families, physicians, vendors and community agencies in word, action, and appearance.

Physical, Mental, Miscellaneous Demands

Prolonged sitting required, with the ability to operate office equipment which may include heavy lifting, bending, and standing.

Requires ability to use up to 50 pounds of force occasionally and/or up to 20 pounds of force frequently and/or up to 10 pounds continuously to move objects.
Requires ability to grasp, pull, push, carry or otherwise manipulate objects; ability to perform tasks requiring action of muscles or groups of muscles and foot and/or hand-eye coordination.
Work deals mostly with areas such as preparing and reading data and figures, records, reports, visual inspection involving small details. Although important, depth perception and field of vision (peripheral) are not as critical as the ability to distinguish small details and markings very near to the observer.
Position requires sitting approximately 60% of time standing/stooping/bending/ climbing approximately 20% of time; and walking approximately 20% of time.
Requires ability to concentrate on fine detail with frequent interruption; ability to focus attention on tasks for 10-20 minutes at a time on a continuous basis, 20-60 minutes on occasion.

Requires the ability to remain calm and courteous under stress.
Requires working under strict turnaround time guidelines to meet business needs.

Requires ability to communicate clearly and make self-understood effectively in face-to-face interactions; articulate with accuracy to communicate using phone.
Requires ability to hear and receive verbal instructions correctly, answer phones, communicate professionally in situations with some background noise.
Requires ability to understand and relate to specific ideas one at a time and to the concepts behind specific ideas; ability to remember verbal and written tasks/assignments from a few hours to several day periods.
Excellent computer software skills necessary to produce accurate documents and materials required.
Working knowledge of MS Office, Excel or similar software required. Proficient knowledge preferred.
Requires ability to work effectively under minimal supervision; exercise excellent, sound professional judgment and maintain confidentiality.