Insurance Authorization Specialist

» Insurance Authorization Specialist
Healthcare
in Orlando
, FL
Reference: 19-03651

Description: 

This person will be responsible for reviewing authorizations, requesting extensions, and workers compensation.

Qualifications:

  • Five years minimum of insurance authorization experience
  • Experience working with and authorizations with different types of insurance companies (BCBS, Atena, Humana, Tricare and so on)

Job Responsibilities:

  • Patient Care Coordination
    • Answer phones and take care of patients’ questions and concerns
    • Provide customer service
    • Schedule equipment set-ups and pick-ups
    • Get all required information (i.e. verify address, directions, payment information, etc) to set up a patient with equipment
    • Follow up with total knee replacement patients and/or post- op patients to find out discharge date from hospital/status
    • Handle all incoming pop-up orders accordingly
  • Billing
    • Request authorization for any type of insurance, including medicare Replacement HMOs, commercial insurances, etc.
    • Initiate referrals process with Medicare HMO plans
    • Assure that insurance gets verified electronically or via phone
    • Ensure that diagnosis and HCPS and units are correct and match item provided to patient, as well as authorization
    • Familiar with billing process
    • Initiate appeals process for denied authorizations
    • Initiate workers compensation authorizations, negotiate pricing with adjusters and third parties
  • Administrative
    • Maintain tracking boards
    • Create cards for all orders
    • Track progression from Probability‚ÜíTo Be
    • Maintain Patient Tracking Log
    • Create schedule for Patient Care Representatives
    • Record meeting minutes
    • Track overdue script list
    • Distribute faxes
    • Enter/track order in Cortex, in Busy Cal, in the Patient Tracking log
    • Create files for all orders
    • Make sure all necessary information is in the file
    • Request clinical notes from doctors’ offices
    • Assist Office Manager and Billing Coordinator
  • Insurance Verification/Payment Arrangements
    • Verify status of patients’ insurance, auto or workers compensation coverage
    • Offer patients private pay rate for non-covered equipment and non-covered rental extensions
  • Coordinate Patient Care Representatives Schedule
    • Print a daily schedule listing all set-ups and pick-ups
    • Include set-up tickets with maps and directions
    • Include pick-up tickets with maps and directions
    • Include any equipment exchanges
    • Supply accurate directions and maps to locate patients home
    • Coordinate weekend schedule
    • List all scheduled set-ups
    • List all possible set-ups