[Hiring] Surgery Insurance Verification/Authorization Specialist @ENT ASSOCIATES

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.

• Contact various insurance companies either by phone or online 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 referrals 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 HIPAA guidelines to release medical records.
• Maintain professional and timely communications with surgery schedulers and physicians.

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

• Physical demands: Average percent of time during regular shift devoted to:
  • Walking, Squatting, Sitting, Bending, Reaching: 75%
  • Standing: 25%
• Average lifting requirements:
  • Lifting Requirements: 20-40 lbs.
  • Frequency of Lifting: 0-25% of the time
• Additional physical demands:
  • Ability to grasp with both hands; pinch with thumb or forefinger; turn with hand/arm; reach for (above shoulder height).
  • Ability to type 60 wpm.
  • Ability to operate multi-line telephone system, computer keyboard, and ten-key adding machine.
• Visual, Hearing, and Mental demands:
  • Vision adequate to perform essential functions such as reading telephone displays/computer terminals for long periods of time, correctable to 20/20.
  • Hearing is adequate to perform essential functions such as answering the telephone.
  • Mental capacity adequate to perform essential functions such as quickly and accurately entering patient demographics and scanning documents while checking in multiple patients.
  • Tact to deal with unfriendly individuals regarding various situations, and adequately handle stress.

Working Conditions

• This position has an option to work from home after training has been completed.
• Performance, reliability, and overall fit for the role will be assessed prior to an employee being given permission to work remotely and will continue to be assessed once the employee has gone remote.
• Required to exhibit a positive attitude and a professional appearance and show detail and accuracy.
• Required to exhibit quality performance of the essential job functions to help the practice run effectively and efficiently.