[Hiring] Team Lead: Prior Auths & Insurance Verification @GetixHealth

Role Description

Are you ready to take your leadership skills to the next level? We’re looking for an enthusiastic Team Lead (Prior Auths & Insurance Verification) to join our growing team! In this role, you’ll be the go-to person for guiding and motivating our follow-up specialists to provide exceptional service while making insurance verification and prior auths feel like a breeze. If you’re passionate about coaching, problem-solving, and creating a positive team environment, this is the perfect opportunity for you!

Insurance Team Lead is an important position that allows GetixHealth to help our clients resolve their outstanding accounts receivable which can lead to additional business, provide us the opportunity to employ more people and increase GetixHealth’s footprint in the healthcare sector. The Team Lead must possess the ability to work independently, have excellent customer service and communication skills, patience, flexibility, and the ambition to achieve goals. Fast paced environment with multiple facilities.

Responsibilities

• Review self-pay accounts to verify insurance coverage.
• Analyze and resolve unpaid claims.
• Contact insurance carriers for claim status and payments.
• Research claims using online tools.
• Gather and submit supporting documentation to insurance carriers.
• Submit appeals when necessary.
• Review and apply contractual terms.
• Communicate with patients/guarantors to expedite claims.
• Assist with special projects and additional duties as needed.
• Ensure compliance with information security policies.
• Monitor inventory and provide reporting on open claims.
• Report security risks as per procedures.

Pay

Pay range: $25.00 based on experience (Bonus eligibility).

Benefits

• Comprehensive Health Coverage: Group medical, dental, and vision plans available from the first day of the month following 90 days of full-time employment.
• Life and Disability Insurance: Basic life/AD&D, short-term, and long-term disability coverage provided, with options for voluntary life/AD&D.
• 401(k) Retirement Savings Plan: Eligible to participate in the company’s 401(k) plan at the beginning of the first calendar quarter following 6 months of continuous service.
• Paid Time Off (PTO): Accrue Paid Time Off starting on your first day of employment.
• Flexibility in Benefits: The company reserves the right to amend, modify, or terminate any benefits programs as needed.

Qualifications

• 7+ years’ experience in a facility setting performing insurance follow-up/denials management.
• Knowledge of UB04/CMS 1450 and CMS 1500 claim forms, EDI, HCPCS, ICD-9/ICD-10, CPT, DRG’s and ability to interpret an Explanation of Benefits.
• Complete working knowledge of billing instructions and procedures for each payer source according to regulations and guidelines.
• Knowledge of Commercial, Governmental and third-party denials and appeals processes.
• Knowledge of billing systems.
• Must have effective organizational skills and a high attention to detail.
• Medical terminology required.
• Must demonstrate the ability to adapt to change, maintain professionalism in challenging situations, and work in a Business professional environment.
• Medi-Cal knowledge a major benefit.
• High school diploma or college degree from an accredited college or university.

Work Environment / Physical Requirements

• Work environment is an office location.
• The position requires the dexterity to operate office equipment such as a personal computer, keyboard, mouse and telephone.
• Occasional lifting may be required up to 25 lbs.
• Must be able to sit for extended periods of time with frequent bending and stooping.

Additional Notes

This role profile is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities or working conditions associated with the position. Must possess the ability to work independently, have excellent customer service and communication skills, patience, flexibility, and the ambition to achieve goals. Fast paced environment with multiple facilities.

GetixHealth is an equal employment opportunity employer.