Eligibility, Benefits, Prior Authorization Specialist

Autism Diagnosis Group; Deutschland; Vor Ort; EUR 45.000 - 65.000; Vollzeit

Zusammenfassung

Jobtailor is seeking an experienced insurance verification specialist to support our healthcare clinics in Germany. You will verify coverage, deductibles, co-pays, and co-insurance across commercial plans and coordinate benefits to ensure smooth patient billing.

Collaborating with clinical teams, you will navigate payor portals, track policy changes across states, and prepare patient benefit letters while maintaining accurate data in the EMR.

Qualifikationen

• 2+ years of healthcare clinic or startup experience specializing in insurance verification and prior authorizations
• Strong research capabilities: deep comfort navigating payor portals, digging through policy manuals, and calling payor representatives to clarify ambiguous rules
• Hands‑on experience working with multiple major commercial payers (e.g., BCBS, Optum, Aetna)
• Working knowledge of medical terminology, CPT, ICD‑10, and telehealth billing modifiers
• Excellent written and verbal English communication skills: ability to translate technical insurance terms into simple, clear explanations
• High‑speed internet, backup power setup, and the ability to work full‑time during EST business hours

Aufgaben

• Verify active patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across commercial plans
• Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.)
• Navigate payor websites, newsletters, and provider manuals to track and document shifting policy guidelines and billing modifiers across 40+ states
• Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD-10 data are flawless
• Initiate, track, and validate prior authorizations through clearinghouses (e.g., Availity, Waystar), insurance portals, and phone escalations
• Ensure all authorizations are secured, confirmed accurate, and fully documented in the EMR before the close of business each day for upcoming clinics
• Act as the go-to resource for clinical teams when a payer's prior-authorization process is vague, contradictory, or unmapped
• Validate conflicting information from multiple insurance sources to determine the most credible, risk-free path for claim submission
• Build, update, and maintain internal state-by-state reference guides on commercial insurance and state-by-state regulatory requirements
• Prepare clear, professional patient insurance benefit letters outlining estimated out-of-pocket costs and referral requirements
• Collaborate closely with clinic coordinators and clinical staff to resolve last-minute scheduling exceptions or authorization gaps
• Help de-escalate patient or provider concerns regarding coverage limits with professional, empathetic communication

Kenntnisse

Insurance verification

Prior authorizations

Research capabilities

English communication

Tools

Payor portals

Availity

Waystar

Jobbeschreibung

Responsibilities

• Verify active patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across commercial plans
• Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.)
• Navigate payor websites, newsletters, and provider manuals to track and document shifting policy guidelines and billing modifiers across 40+ states
• Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD-10 data are flawless
• Initiate, track, and validate prior authorizations through clearinghouses (e.g., Availity, Waystar), insurance portals, and phone escalations
• Ensure all authorizations are secured, confirmed accurate, and fully documented in the EMR before the close of business each day for upcoming clinics
• Act as the go-to resource for clinical teams when a payer's prior-authorization process is vague, contradictory, or unmapped
• Validate conflicting information from multiple insurance sources to determine the most credible, risk-free path for claim submission
• Build, update, and maintain internal state-by-state reference guides on commercial insurance and state-by-state regulatory requirements
• Prepare clear, professional patient insurance benefit letters outlining estimated out-of-pocket costs and referral requirements
• Collaborate closely with clinic coordinators and clinical staff to resolve last-minute scheduling exceptions or authorization gaps
• Help de-escalate patient or provider concerns regarding coverage limits with professional, empathetic communication

Requirements

• 2+ years of healthcare clinic or startup experience specializing in insurance verification and prior authorizations
• Strong research capabilities: deep comfort navigating payor portals, digging through policy manuals, and calling payor representatives to clarify ambiguous rules
• Hands‑on experience working with multiple major commercial payers (e.g., BCBS, Optum, Aetna)
• Working knowledge of medical terminology, CPT, ICD‑10, and telehealth billing modifiers
• Excellent written and verbal English communication skills: ability to translate technical insurance terms into simple, clear explanations
• High‑speed internet, backup power setup, and the ability to work full‑time during EST business hours

Core Competencies

Demonstrates expertise in insurance verification and prior authorizations, with a strong ability to navigate payer policies and communicate effectively with clinical teams and patients. Proficient in medical terminology, CPT, ICD‑10, and telehealth billing practices.