[Hiring] Authorization & Eligibility Coordinator @Raintree Systems

Role Description

The Authorization & Eligibility Coordinator ensures quality and timely benefit/eligibility verifications along with the management of client enrollment and credentialing for multi-specialty medical professional services with various insurance payers via our electronic clearinghouse or insurance web portals.

• Responsible for the verification and eligibility of patient health insurance benefits via external insurance web portals or over the phone.
• Responsible for authorization submission as needed based on patient's health insurance requirements via external insurance web portal or over the phone.
• Assures all insurance information has been completely and accurately obtained. Documents all pertinent insurance eligibility information.
• Documents information given or received to support actions taken on insurance issues.
• Assures all authorization information is documented completely and accurately for claims processing.
• Review, evaluate and assist in creating processes and workflows for future benefit and authorization teams.
• Monitor authorization exceptions to ensure timely claim billing.
• Communicate with clients regarding authorization or eligibility issues or trends.
• Assist external departmental personnel in strategically critical issues as the need arises.

Qualifications

• High School Diploma, GED, or equivalent work experience.
• Requires consistent judgment using software and industry expertise to analyze client needs and processes.
• Ability to teach end users in the solution's optimal use, which is different for every client.
• Requires knowledge of multiple medical specialties and the rules regarding their billing and documentation.
• Understanding of accounting principles governing corporate reporting.
• Understanding of software engineering/development processes.

Requirements

• Well-developed verbal, listening and phone communication skills.
• Good written communication skills with the ability to write routine correspondence.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to define problems, collect data, establish facts, and identify trends.
• Ability to exercise good judgment and escalate issues appropriately.
• Strong organizational skills and ability to execute manual detailed tasks.
• Strong customer service focus and commitment.
• Ability to establish and maintain effective working relationships within the team.
• Ability to work well with diverse personalities.
• Tactful, mature and flexible.
• Ability to work remotely. Strong video conferencing etiquette.

Benefits

• Remote Work/Work From Home.
• Paid Time Off/11 Paid Holidays/Year-End Holiday Break.
• Health, Dental, Vision, HSA/FSA.
• 401K with Company Match.
• Disability & Life Insurance.
• Employee Assistance Program.
• Paid Parental Leave.