insurance authorization specialist

ATI Physical Therapy

<div><div>The Authorization Specialist is responsible for obtaining authorizations for our patients by providing the appropriate forms and clinical data to insurance companies. This role works with Revenue Cycle staff members and Clinicians to coordinate the authorization process in a timely and accurate manner for various carriers.</div><div></div><div> 
This is a hybrid role that includes working on-site for initial training period and quarterly staff meetings.</div><ul><li> 
Develop relationships with Nurse Case Managers/Adjusters to provide top notch customer service experience.</li><li>Verify and obtain authorizations as required by insurance companies dependent upon the plan coverage for all patients.</li><li>Accurately enter authorized dates, visit or units into ATI&rsquo;s Electronic Medical Records (EMR) to correctly track therapy services.</li><li>Coordinate efforts and communication between the insurance companies and the clinic regarding insurance specific forms and timelines so that the patient is authorized throughout any continued care that is needed.</li><li>Provide feedback for authorization changes according to insurance plan changes.</li><li>Collaborate with the Central Billing Office for missed authorizations while the patient was being seen for therapy service.</li><li>Efficiently handle the assigned authorization workload to assure timely completion of requests.</li><li>Ensure compliance to departmental and company policies and procedures.</li><li>Complete all assigned training programs.</li><li>Collaborate with team members with supportive communication, respect, and appropriate feedback.</li></ul><div> 
Minimum Education 
Required: 
<ul><li>High School diploma</li></ul></div><div></div><div> 
Minimum Experience 
Required: 
<ul><li>1 year of Healthcare or Health Insurance experience.</li></ul></div><div></div><div> 
Knowledge, Skills, and Abilities 
<ul><li>Strong organization skills to initiate and follow-up on authorizations.</li><li>Attention to detail.</li><li>Ability to multitask.</li><li>Ability to collaborate with internal and external teams.</li><li>Ability to provide clear direction through written and verbal communication.</li><li>Strong customer orientation.</li><li>Excellent interpersonal and communication skills.</li><li>Proficient in Microsoft Office (Word, PowerPoint, Excel).</li></ul></div></div>

MSA Authorization Specialist

Integral Care-Austin, TX

<div>
 
 Job Number:
 
 26-11098
 
 
 
 Job Summary:
 
 The Authorization Specialist is responsible for daily oversight of authorization request and approvals requiring interface with internal and external persons/entities and any other activities related to reimbursement for services of Crisis residential/respite programs. Performs regular updates and verification of insurance coverage. Other regular work duties may also involve meeting and greeting clients, facilitating client information, requesting payment for services rendered, handling various types of payments, issuing receipts for payment, retrieving message off facility voicemail, provide continuity of care email info for court related collaborators, building schedules in the Electronic Health Record for the providers, scanning client docs, supplies inventory/ordering/stocking, submission of work order requests, etc. and other duties as requested/assigned. This position provides a variety of moderately complex clerical work in support of the unit operations. Assignments involve difficult and responsible work in office, business, or fiscal operations with moderate latitude for the use of initiative and independent judgment. The Authorization Specialist works under the direct supervision of the unit Practice Manager and in collaboration with the multi-disciplinary team to help meet and assist clients' needs.
 
 
 Regular, predictable attendance is considered to be an essential requirement for this position. Other duties may be assigned. May require a flexible work schedule.
 
 
 Integral Care employees are to strive to maintain a trauma sensitive workplace, to embrace trauma sensitive and informed practices, and to foster a supportive and welcoming environment of care.
 
 
 
 Education
 
 
 
 Required:
 
 
 <ul>
 <li>
 High School Diploma or GED equivalent required.
 
 
 </li>
 </ul>
 
 License
 
 
 
 Required:
 
 
 <ul>
 <li>
 Current and valid driver's license and a clean driving record.
 
 
 </li>
 </ul>
 
 Hours:
 
 Full-Time.
 
 
 
 Workdays:
 
 Monday - Friday.
 
 
 
 Workhours:
 
 8:00AM - 5:00PM.
 
 
 
 Salary:
 
 $23.02 an hour plus an additional 10% crisis stipend.
 
 
 
 Why join us:
 
 Integral Care has proudly served Travis County residents for the past 50 years. As the largest provider of behavioral health services in Travis County, we are dedicated to improving the lives of adults and children living with mental illness, substance use disorder, and intellectual and developmental disabilities.
 
 
 By joining our team, you will find rewarding work every day alongside people who have as much compassion as you. Join us and together we can help improve the quality of life for the people we serve. Imagine your career at Integral Care!
 
 
 
 Employee Benefits
 
 
 
 <ul>
 <li>
 Medical, Dental, and Vision insurance
 </li>
 <li>
 Generous vacation/holiday/sick leave
 </li>
 <li>
 Life and Short-term/Long-term Disability Insurance
 </li>
 <li>
 Employee Assistance Program (EAP)
 </li>
 <li>
 403(b) retirement account
 </li>
 <li>
 Gold's Gym membership discount
 </li>
 <li>
 Mileage reimbursement
 
 
 </li>
 </ul>
 All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, national origin, sexual orientation, gender identity, disability, veteran status, sex or age.
 
 
 For specific positions, additional compensation may be offered to candidates who are bilingual in English and another language deemed necessary for the role.
</div>

Authorization Specialist

Veins OC

Job Overview We are seeking a proactive and detail-oriented Prior Authorization Specialist to join our healthcare team. In this vital role, you will be responsible for managing the authorization process for medical varicose vein clinic, ensuring timely approvals that facilitate seamless patient care. Your expertise in managed care policies, medical terminology, and insurance procedures will drive efficiency and accuracy in processing prior authorizations. This position offers an exciting opportunity to contribute to a dynamic healthcare environment where your skills directly impact patient outcomes and provider satisfaction.Responsibilities<ul><li>Review and evaluate prior authorization requests for varicose vein treatments, ensuring all documentation complies with insurance requirements and clinical guidelines</li><li>Communicate effectively with healthcare providers, insurance companies, and patients to gather necessary information and clarify authorization statuses</li><li>Verify insurance coverage, eligibility, and benefits using insurance verification tools and systems</li><li>Maintain detailed records of authorization requests, approvals, denials, and related correspondence in accordance with HIPAA regulations</li><li>Utilize CPT coding, ICD-9, ICD-10, and ICD coding standards to accurately document procedures and diagnoses for authorization purposes</li><li>Collaborate with medical office staff to facilitate smooth workflow and timely processing of authorizations</li><li>Stay updated on managed care policies, insurance plan changes, and coding updates to ensure compliance and accuracy</li></ul>Requirements<ul><li>Proven experience in managed care environments or medical office settings with a focus on prior authorizations</li><li>Strong knowledge of medical terminology, medical records management, and medical coding including CPT, ICD-9, ICD-10 codes</li><li>Familiarity with HIPAA regulations to ensure patient confidentiality and data security</li><li>Experience with insurance verification processes within healthcare VARICOSE VEIN TREATMENT AUTHORIZATONS SUCH AS ABLATION, VARITHENA AND SCLEROTHERAPY PROCEDURES</li><li>Excellent communication skills for liaising between providers, insurers, and patients</li><li>Office experience with proficiency in electronic health records (EHR) systems or similar software</li><li>Knowledge of medical billing procedures and familiarity with medical records management is a plus</li></ul>Join us to be part of a dedicated team committed to delivering exceptional patient care through efficient authorization processes. Your expertise will help streamline operations while supporting the health and well-being of our patients.Pay: $25.00 - $29.00 per hourWork Location: In person

Prior Authorization Specialist

Puget Sound Home Health and Hospice

<div>Join Our Team as an Insurance Prior Authorization Specialist at Puget Sound Home Health &amp; Hospice.
Benefits:<ul><li>
$23-28 per hour, DOE</li><li>
Comprehensive Medical, Dental, and Vision insurance</li><li>
Free health concierge services</li><li>
FSA and HSA accounts</li><li>
Paid Life and AD&amp;D insurance</li><li>
Paid Sick, Holidays, and PTO</li><li>
STD, LTD, and other voluntary insurance plans</li><li>
Company-wide celebrations of your great work &amp; accomplishments</li><li>
Support for your professional growth and development</li><li>
Room for advancement</li><li>
AMAZING teammates &amp; leaders who are supportive, inclusive, and fun!</li></ul>
What Do We Require of a Prior Authorization Specialist?
<ul><li>Must have at least 1 year of insurance authorization/billing experience in a medical office, preferably home health/hospice.
</li><li>Experience with Home Care Home Base is strongly preferred</li><li>
Demonstrated cooperation and excellent customer service skills</li><li>
Ability to multi-task and stay on task in a fast-paced office</li><li>
Excellent team-oriented, verbal, and written communication skills</li></ul>
Key Responsibilities:<ul><li>
Verify insurance coverage, including primary and secondary payors</li><li>
Use UGS/DDE and EDS programs to verify Medicare/Medicaid eligibility</li><li>
Obtain visit authorization via payor by providing appropriate medical records</li><li>
Perform accurate data entry in patient records within HCHB</li><li>
Maintain payor files with up-to-date requirements to obtain/initiate appeals for denied authorizations</li><li>
Interface with contract, clinical, and office staff to foster collaboration and positive working relationships</li><li>
Prepare patient co-pay estimates and notify scheduling of authorized visits</li><li>
Provide excellent customer service to patients, referral sources, and community contacts with questions regarding payor prior authorizations and medical guidelines</li><li>
Enter, audit, and follow up on authorized and unauthorized visits within HCHB</li></ul>
Why Puget Sound Home Health &amp; Hospice?
At Puget Sound Home Health &amp; Hospice, we pride ourselves on our quality of care and ethical business practices, guided by our foundational Core Values of CAPLICO:<ul><li>
Customer Second (Employee First!)</li><li>
Accountability</li><li>
Passion for Learning</li><li>
Love One Another</li><li>
Intelligent Risk Taking</li><li>
Celebration</li><li>
Ownership</li></ul>
www.pugetsoundhhh.com<div><div><div><div><div><div><div><div><div><div><div><div><div><div>
The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com.</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>

Prior Authorizations Specialist

Avera Health

<div><div><div><div><div><div><div><div>Location:
</div></div></div></div></div></div></div>Avera Marshall Hospital
Worker Type:
Regular
Work Shift:
Day Shift (United States of America)
Pay Range:
The pay range for this position is listed below. Actual pay rate dependent upon experience.
$19.50 - $25.50
Position Highlights
Monday - Friday, 8:00 AM - 4:30 PM 
 
You Belong at Avera
Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. 
 
A Brief Overview
 
 
Responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Specialists are responsible for documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. The Specialist must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Specialists must also be able to understand and interpret patient liability and benefits for all payer types including copays, co-insurance, and out-of-pocket responsibilities in order to provide patients and families with information on their financial responsibility. The Specialist will calculate and communicate to the patient a financial responsibility estimation, provide charity applications and/or direct the patient to the business office for payment and assistance options. The Specialists will collect patient liability prior to service and attempt to collect prior balances. The Specialist collaborates with various other departments to ensure proper reimbursement on accounts. The Specialists are to conduct all transactions appropriately and consistently, and complete government regulatory forms accurately with the patient or patient's representative. Specialists must maintain compliance with government regulations (i.e. EMTALA and HIPAA) as it pertains to the insurance process.
 
 
What you will do 
 
 
<ul><li>Process eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Specialists must verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons.
</li><li>Identify all payment sources for accurate primary and secondary payer coverage and required authorizations to prevent denials and/or reduction in payment for patients entering the facility for care.
</li><li>Obtain necessary paper/electronic referrals, authorizations and pre-certifications from Primary Care Physician and/or Specialty Physician when required by payers, Managed Care, and traditional Medicaid and enters information into the health information system.
</li><li>Collects and validates accurate patient demographic and insurance information, verifies insurance, obtains pre-certification/authorization as required and enters all necessary information.
</li><li>Calculate and communicate patient estimates for hospital services utilizing a deposit matrix or patient payment estimator to determine estimated patient responsibility and communicates financial expectations to the patient.
</li><li>Educates patients on their benefits, offers the patient/family the opportunity to pay their estimated patient responsibility prior to services rendered, and identifies methods of payment available. Identifies patients in need of financial assistance and provides charity applications and referrals to the business office as necessary.
</li><li>Responsible to screen all self pay patients for potential payer coverage and directs applicable accounts to the advocacy team for further review. Assure all payer requirements are met, including non-coverage waivers, Advance Beneficiary Notices, sterilization forms, and other forms as applicable.
</li><li>Provide communication concerning change of insurance coverage, prior to billing, from Registration staff and/or Patient Advocate/Billing staff.
</li><li>Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry.
</li></ul> 
Essential Qualifications
 
 
The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
 
 
Required Education, License/Certification, or Work Experience: 
 
 
<ul><li>1-3 years Related experience in billing, insurance or registration.
</li><li>1-3 years Healthcare experience
</li></ul> 
Preferred Education, License/Certification, or Work Experience: 
 
 
<ul><li>Associate's finance, business or healthcare.
</li></ul> 
Expectations and Standards 
 
 
<ul><li>Commitment to the daily application of Avera&rsquo;s mission, vision, core values, and social principles to serve patients, their families, and our community.
</li><li>Promote Avera&rsquo;s values of compassion, hospitality, and stewardship.
</li><li>Uphold Avera&rsquo;s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
</li><li>Maintain confidentiality.
</li><li>Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
</li>Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable. 
<li>
</li></ul> 
Benefits You Need &amp; Then Some
Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.
<ul><li>PTO available day 1 for eligible hires.
</li><li>Up to 5% employer matching contribution for retirement
</li><li>Career development guided by hands-on training and mentorship
</li></ul>Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org .</div>

Insurance Specialist

Brite Health Care

Stable Durable Medical Equipment (DME) Company is ready to expand its medical insurance verification team.You must live in Katy or West Houston for this position!We are a high volume health care company looking to welcome the right person for this challenging and fast-paced position as an Experienced Insurance Verification Specialist within our well-established company.This is not an entry-level position so the ideal candidate will have at least 2 years&rsquo; experience with medical insurance verification related to DME items.***PLEASE NOTE***For this position, insurance verification does not mean checking to see if a patient has insurance or if the insurance is current.In this position, you must check to see what DME benefit coverage the plan offers, determine the patient&rsquo;s deductible and Out-of-Pocket status, and if the DME items on order require authorization before they can be approved. Employee must get insurance authorization for those plans that require this extra step.Must Possess:<ul><li>Knowledge of ICD10, HCPCS Codes, and medical terminology</li><li>Experience contacting insurance providers, determining coverage benefits as well as deductible status</li><li>Familiarity with various insurance plans and respective verification portals</li><li>High attention to detail and accuracy</li></ul>Must Be:<ul><li>Computer literate</li><li>Driven to perform at a high level</li><li>Professional</li><li>Articulate</li><li>Able to work well with others</li></ul>Must Have:<ul><li>Polite phone etiquette; customer service oriented</li><li>10 key experience a plus, type at least 45wpm</li><li>Knowledge of medical billing coding</li><li>Dependable Transportation</li><li>High school or equivalent education</li></ul>Bilingual in English/Spanish a plus.This is a full time, hourly position with health, dental, vision insurance benefits as well as paid time off. Please send your resume and references. Salary range is $13.00 - $18.00 per hour. This position offers substantial growth opportunity. Again, this is not an entry level position. Only well qualified candidates, living in Katy or West Houston, will be considered.Office hours are Monday through Friday 8:30 to 5:00.Reply to HRRecruiters, please don't contact us! Do NOT contact us with unsolicitedservices or offersJob Type: Full-timePay: $13.00 - $18.00 per hourBenefits:<ul><li>Dental insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Experienced DME Insurance Verification

Neurology Texas

<div>Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Patient Referral Specialist today with Neurology Texas.
<h5 class="jobSectionHeader">Job Summary and Qualifications</h5>
<h5 class="jobSectionHeader">GENERAL SUMMARY OF DUTIES: 
 
Processes physician, hospital, and outpatient referrals. Responsible for patient scheduling, obtaining insurance authorization, and providing appropriate guidance regarding insurance coverage. Essential duties and responsibilities are as follows. Other duties may be assigned.
PRACTICE REQUIREMENTS: Position eligible to be utilized in practices who see &gt; 50 patients daily 
 
DUTIES INCLUDE BUT NOT LIMITED TO:
<ul><li>Works collaboratively with all diagnostic and surgical service areas, physician offices and hospitals to ensure timeliness, accuracy and completeness when scheduling patient appointments, tests and procedures.
</li><li>Consistently provides accurate and detailed patient information to include patient demographics and medical information pertinent to appointment being scheduled to ensure patient safety and quality patient care.
</li><li>Determine insurance eligibility and authorization for medical office and/or surgical visits; or works with authorization coordinator to ensure all payor authorizations have been received.
</li><li>Initiate EMR by entering demographics, referring and certifying physicians, and family information; obtaining needed medical records from referring providers.
</li><li>Establish rapport with all offices, hospital personnel, and managed care representatives.
</li><li>Utilize EMR or other designated programs to capture and track referrals.
</li><li>Obtains accurate and valid physician or advanced practitioner orders for all appointments, tests and procedures being scheduled.
</li><li>Accurately and consistently communicates appointment, test, procedure information and prep to patient and/or family member. Adheres to privacy, compliance and HIPPA regulations.
</li><li>Ensure patient has follow-up appointment with the physician to discuss outcomes, as appropriate.
</li><li>Consistently and accurately document the date and time of appointment, tests, scan or procedure in the patient's medical record. Communicate as appropriate to practice staff and ensures the referral process is completed and closed.
</li><li>Outgoing referrals submitted same day, preferably with patient present to obtain the optimal appointment.
</li><li>Weekly reporting to practice leadership on referral volume, referral status, and follow up on outstanding appointments.
</li><li>Performs related work as required.
</li><li>Practice and adhere to the Code of Conduct and Mission and Value Statements.
</li></ul>EDUCATION: 
 
High School Diploma or GED equivalent
EXPERIENCE:
One year of experience in referral coordination relating to insurance provider tier levels, insurance authorizations, and out of network procedures required 

 
CERTIFICATION/LICENSE:
None required 
 
KNOWLEDGE, SKILLS AND ABILITIES: 
 
<ul><li>Knowledge of medical terminology.
</li><li>Knowledge of common safety hazards and precautions to establish a safe work environment.
</li><li>Establishing and maintaining effective working relationships with patients, medical staff and the public.
</li><li>Must have good interpersonal skills.
</li><li>Ability to communicate effectively both verbally and in writing, and keep a positive attitude with patients, peers, providers, employers, insurers, and family members.
</li><li>Must be flexible and able to handle multiple tasks
</li><li>Word processing and Excel experience preferred.
</li><li>Good organizational skills
</li></ul>Benefits</h5>
Neurology Texas, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li>
Wellbeing support, including free counseling and referral services</li><li>
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li>
Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li>
Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li>
Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
Supporting HCA Healthcare's 186 hospitals and 2,400+ sites of care, Physician Services plays a crucial role as the main entry point for patients looking for high-quality healthcare within the HCA Healthcare system. With a focus on meeting the needs of our patients at all access points, Physician Services is dedicated to implementing innovative, physician-driven, value-added solutions to assist physicians in providing high-quality, patient-centered care, aligning with our mission to care for and enhance human life.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. 
&quot;The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Patient Referral Specialist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Patient Referral Specialist

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