Role Description

The Surgery Insurance Verification/Authorization Specialist is responsible for the insurance verification and obtaining authorizations on all insurance plans for all In-Office, ASC, and Outpatient Surgeries. Insurance benefits are verified utilizing online insurance website resources or research which may require outbound phone calls to insurance companies. Once the insurance has been confirmed active, benefits are documented in the EMR. Authorization is requested utilizing online insurance portals, submission of authorization request forms, and faxing requests to primary care providers. Once authorization is obtained it is entered into the EMR system. This position works very closely with the surgery schedulers and the ordering providers to ensure there are no delays for scheduled surgeries.

Qualifications

• High School education or GED equivalent.
• Minimum one year of medical office experience preferred.
• Working knowledge of insurance verification process and contracted insurance plans.
• Good verbal and written communication skills.
• Excellent telephone and customer service skills.
• Demonstrated ability to use a computer with Microsoft Word, Outlook and EMR software.
• Strong organizational skills with the ability to multi-task.
• The ability to attend work on a regular basis.
• The ability to adhere to safety rules and other reasonable regulations pertaining to the job.
• The ability to refrain from negativity or excessive irritability.
• The ability to work in cooperation with other workers.
• Ability to maintain confidentiality and thorough knowledge of HIPAA policies and procedures.

Requirements

• Contact various insurance companies either by phone or online website sites to obtain insurance benefits and authorizations.
• Contact patient or PCP to obtain information necessary to verify insurance.
• Verify insurance is accurate, updated and active.
• Verify insurance eligibility and benefits for copay, deductible and coinsurance.
• Obtain pre-certification/pre-authorization from insurance companies.
• Confirm insurances are in-network. If not, notify the surgery scheduler.
• Fax authorization requests to primary care and insurance companies through Provider Flow.
• Maintain updated knowledge of payor policies and guidelines for surgical procedures.
• Scan and enter authorizations and referral into EMR.
• Link Authorization to the surgery appointment in EMR.
• Document accounts in the EMR on surgery orders note task and in appointment comments.
• Add updated insurance to EMR.
• Update PCP and demographics in EMR.
• Scan documents into EMR.
• Import Faxes from Provider Flow to EMR.
• Research enrollment issues due to lack of information or incorrect information.
• Complete all tasks within the timelines established by the practice.
• Answer the telephone in a warm, friendly manner.
• Maintain patient confidentiality.
• Perform other duties as assigned or requested.
• Follow the release of information protocol established by ENTA that follows the HIPAA guidelines to release medical records.
• Maintain professional and timely communications with surgery schedulers and physicians.

Benefits

• Option to work from home after training has been completed.
• Performance, reliability, and overall fit for the role will be assessed prior to remote work permission.
• Required to exhibit a positive attitude and a professional appearance.
• Required to exhibit quality performance of the essential job functions to help the practice run effectively and efficiently.