Authorization and Eligibility Representative

OrthoArizona; Mesa (AZ); On-site; USD 35,000 - 50,000; Full time

Benefits offered by this job

Robust paid time off package

Multiple medical plan options

Health Savings account with company contributions

Dental & Vision insurance

401(k)

Pet insurance

ID Theft protection & Legal assistance

Job summary

OrthoArizona is seeking an Authorization & Eligibility Representative to join our team in Mesa, Arizona. This role requires verifying insurance coverage for both new and existing patients, acting as a liaison between patients and insurance carriers, and maintaining accurate medical records. The ideal candidate will have a high school diploma or GED, with at least 2 years of experience in healthcare administration. Benefits include robust paid time off, medical options, and a 401(k).

Qualifications

• Understanding of health insurance plans and authorization processes.
• Ability to work independently and as part of a team.
• Familiarity with practice management software.

Responsibilities

• Verify and re-verify insurance coverage for patients.
• Act as a liaison between patients and insurance carriers.
• Maintain medical records as per practice policies.

Skills

Excellent customer / patient service

Knowledge of medical terminology

Excellent written and verbal communication skills

Ability to communicate effectively on the telephone

Problem solving abilities

Strong organizational skills

Education

High School diploma or GED

Minimum of 2 years of experience in healthcare administration or related field

Tools

Centricity Software

Phreesia

Job description

Authorization & Eligibility Representative

About OrthoArizona: At OrthoArizona, we are bringing the best together. Our organization was created to help serve ALL orthopedic and podiatry needs throughout the Valley! We have a wide range of orthopedic surgeons and mid-level providers including physical and occupational therapists. Today we are one of Arizona’s largest privately owned and most comprehensive orthopedic practices with more than 75 locally and nationally renowned providers across 30 locations, in addition to 2 ambulatory surgical centers and in house state of the art MRI capabilities. At OrthoArizona we are committed to best-in-class patient care, being a pioneer in research and technology, and most importantly, rewarding and recognizing our employees.

Responsibilities

• Verify insurance coverage for potential new patients, add ons, and re-verify insurance coverage for existing patients.
• Navigate through multiple insurance portals or by phone to obtain necessary insurance benefits.
• Reconciles obtained information within the Practice Management System, EMR, and Phreesia to ensure successful claim processing.
• Responsible for obtaining all referrals and authorizations for Physical Therapy Patients, as required.
• Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected.
• Enter any authorization numbers and expiration dates into the Practice Management System, EMR, and Phreesia for proper claim processing.
• Update pertinent insurance notes in multiple EMR systems for corresponding departments to access.
• Maintain medical records in accordance with practice policies and procedures.
• Using state or federally regulated websites may require personal login credentials.

Minimum Qualifications

• Excellent customer / patient service.
• Knowledge of medical terminology.
• Working knowledge of computer programs.
• Excellent written and verbal communication skills.
• Understand/Perform training on practice management software.
• Ability to promote favorable facility image with physicians, patients, insurance companies, and general public.
• Ability to communicate effectively on the telephone.
• Ability to make decisions and solve problems.
• Working knowledge of health insurance plans including reading plan requirements.
• Follow all Standard Operating Procedures.
• High School diploma or GED.
• Minimum of 2 years of experience in healthcare administration or related field.
• Strong organizational and communication skills.
• Ability to work independently and as part of a team.
• Ability to meet metric deadlines and stay within goal expectations with little oversight.
• Knowledge of medical terminology and insurance authorization processes.

Preferred Qualifications

• Centricity Software and Phreesia Experience

Benefits

• Robust paid time off package including, sick time, holidays, & paid time off!
• Medical with multiple different plan options.
• Health Savings account + company contributions.
• Dental & Vision insurance.
• 401(k)
• Pet insurance.
• ID Theft protection & Legal assistance.