Insurance Verification & Authorization Specialist

Job Description

Job Description

PRIMARY RESPONSIBILITIES:

• Provide patient balance estimates, collect patient payments and verify insurance coverage and benefits for all payers, including Medicare, Medicaid, and commercial insurances
• Answer and respond to telephone, voicemail, email, and faxed inquiries from internal and external customers, which include clients, patients, and insurance carriers, while providing exceptional customer service
• Explain insurance coverage and benefits to patients, as necessary
• Contact patients and external customers regarding inactive insurance coverage to obtain updated insurance information or obtain referrals
• Initiate, submit and obtain prior authorizations
• Possess current knowledge of insurance carrier guidelines, clinical policies, and state guidelines pertaining to referrals and prior authorization
• Process, sort, and direct incoming and outgoing mail to the appropriate teams and departments
• Maintain patient accounts by appropriately notating, updating, and collecting patient demographic, and insurance information
• Request medical records and other patient/provider information, when appropriate
• Processes credit card transactions received from patients and insurance carriers
• Handle patient financial hardship applications and reviews requests for account adjustments
• Supply management team with immediate feedback on issues affecting workflow, reimbursement, and customer service as well as identifies and escalates opportunities for process improvement to management team
• Identify insurance contract opportunities/requirements and communicates to the Payor Relations department
• Adhere to appropriate quality control, confidentiality, and HIPAA guidelines
• Attend staff meetings and report on monthly performance and activities

QUALIFICATIONS, SKILLS & COMPENTENCIES:

• Bachelor’s degree, preferred
• 3 + years in customer service, insurance verification, authorization and insurance billing required
• Previous experience with medical claims processing, insurance verification, authorization, medical records and insurance terminology, required
• Competent with Windows PC Applications, including Microsoft Word and Microsoft Excel. Strong keyboard and navigation skills and ability to learn new computer skills & applications
• Equipped to handle multiple tasks, accurately process high volumes of work, prioritize work and manage time effectively to meet deadlines
• Capable of making decisions and solving problems using established departmental standard operating procedures and guidelines with limited supervision
• Demonstrated effective and appropriate communication styles and interpersonal skills that promote positive and professional working relationships with peers and management team
• Must be well organized, focused, and detail oriented
• Ability to assist with and adapt to departmental and / or company procedural changes
• As this is a hybrid position, must be able to commute to headquarters in Mount Laurel, NJ
• Able to work a 40-hour schedule within the operating hours of the department, 8:30 AM to 9:30 AM start time and ending 5:00 PM to 6:30 PM
• It may be necessary, based on business and departmental need, to work occasional overtime and/or weekends.
• Telecommute work possible, subject to business environmental conditions

BENEFITS:

• Competitive salary and bonus structure
• Health, dental and vision insurance as well as other ancillary benefits
• Retirement savings plan – 401(k) – with company match
• Paid time off (PTO) and holidays
• Professional development and training opportunities
• Employee wellness programs

EEO STATEMENT:

RMX Monitoring, LLC. is an equal opportunity employer who openly supports and fully commits to recruitment, selection, promotion, and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, and/or local laws. Inclusion and diversity amongst our teams is essential to our success.