[Hiring] Eligibility Verification & Authorization Specialist @InStride Health

Role Description

The Eligibility Verification & Authorization Specialist is responsible for supporting our patients and families through health insurance (payor) verification and authorization processes. Core functions include:

• Eligibility verification
• Obtaining authorizations
• Negotiating single case agreements
• Coordinating between the Intake and Billing teams

You will directly support the InStride Intake team as they help our patients enroll in our treatment program, which includes Psychiatry, Therapy, and Coaching services. This position requires collaboration, strong communication, and customer service skills to establish and enhance positive relationships with colleagues, patients, and others.

Responsibilities:

• Verify insurance coverage for patients using electronic verification systems, insurance websites, and phone calls to insurance companies.
• Submit and manage authorization requests through payer portals or by phone calls.
• Determine patient eligibility for insurance benefits by reviewing insurance policies, coverage limitations, and exclusions.
• Communicate with patients to obtain necessary insurance information and update patient records as needed.
• Coordinate with billing staff to ensure accurate billing and reimbursement processes.
• Resolve insurance eligibility and coverage issues by working directly with insurance companies, patients, and the admissions team.
• Stay up-to-date on changes to insurance policies, regulations, and procedures to ensure compliance with industry standards.
• Provide support and guidance to patients regarding insurance coverage, benefits, and financial responsibilities.
• Collaborate with other members of the billing, scheduling, and admissions teams to streamline insurance eligibility and billing processes.
• Provide feedback to the operations and growth leadership on any barriers in the eligibility and authorization process. Offer suggestions for how to improve those processes and enable speed to care.
• Maintain confidentiality of patient information and adhere to HIPAA regulations at all times.

Qualifications

• Minimum of 2 years experience in an eligibility and authorization related role.
• Previous experience in healthcare administration, medical billing, health insurance, or insurance verification preferred.
• Deep understanding of the insurance landscape including relevant terms, policies/procedures, authorization logistics, and ability to navigate through the ‘red tape’.
• Strong proficiency in using Availity to determine eligibility and submit authorization requests.
• Proficiency in Google Suite applications and electronic health record (EHR) systems.
• Familiarity with HIPAA regulations and patient confidentiality requirements.
• Strong task/project management experience. Demonstrated ability to execute independently, with high accountability to get the job done.
• Excellent communication skills, both verbal and written.
• Exceptional attention to detail and accuracy.
• Ability to work independently and as part of a multi-faceted team in a fast-paced environment.
• Comfortable working in a fast-paced environment.
• High school diploma or equivalent; associate or bachelor’s degree preferred.

Requirements

• The expected annual salary for this role is between $52,000-55,000. Actual starting salary will be determined on an individualized basis and will be based on several factors including but not limited to specific skill set, work experience, etc.

Benefits

• Generous benefits package (401k with match, Flexible PTO, paid holidays, paid service days, 4 week paid sabbatical, 12 week paid parental leave, health benefits starting on your first day, and more).
• Opportunity to join a mission-driven company that is changing the landscape of pediatric mental health treatment.
• Chance to make a far-reaching impact by helping children and families access desperately-needed, evidence-based care.
• Opportunity to work with talented and experienced team members who have devoted their lives to solving this problem.
• Fully virtual: work from the comfort of your home with periodic in-person retreats.
• Commitment to Diversity, Equity, Inclusion, & Belonging (DEIB).