Authorization & Billing Support Specialist, Senior

SB CLINICAL PRACTICE MANAGEMENT PLAN INC; Stony Brook (NY); On-site; USD 50,000 - 70,000; Full time

Job summary

SB Clinical Practice Management Plan Inc is hiring a Senior Authorization & Billing Support Specialist in Stony Brook, New York. This full-time position involves assisting the Medical Coding Manager with operations, validating insurance, appealing denials, and providing administrative support. Candidates should possess an associate's degree or equivalent experience along with exceptional organizational and communication skills. Experience with Cerner and insurance procedures is preferred. The role is primarily on-site, offering a collaborative environment.

Qualifications

• Associate’s degree or 2 additional years of experience in a healthcare setting.
• Three years of experience in a physician practice or healthcare environment.
• Experience with insurance verification and prior authorizations.

Responsibilities

• Validate patient insurance and appeal denials.
• Collect insurance referrals and prior authorization for testing.
• Educate staff on insurance policies.

Skills

Organizational skills

Communication skills

Attention to detail

Microsoft Office proficiency

Education

Associate’s degree or 2 years relevant experience

Bachelor’s Degree (preferred)

Tools

Cerner

IDX

Job description

Authorization & Billing Support Specialist, Senior - Department

Schedule: Full time

Days/Hours: Monday - Friday; 8:30 AM - 5:00 PM

Pay: Our compensation philosophy aims to provide marketable compensation programs and to compensate employees based on relevant experience and education. Individual compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries vary depending on experience, education and current market for the position. Human Resources determines the external and internal equitable salary for each employee. The above salary range (or hiring range) represents Stony Brook CPMP’s good faith and reasonable estimate of the range of possible compensation at the time of posting

SUMMARY
Assist the Medical Coding Manager with the day‑to‑day operations of the coding unit. This position will provide general administrative and clinical office support. Acts as a liaison between patients and physicians regarding insurance policies and procedures.

Job Responsibilities:

• Validate patient insurance.
• Appeal denials, write appeal letters giving medical necessity and provide medical records to support the appeal.
• Review Task Manager regularly, respond to denials and open encounters posted to Task Manager, make corrections.
• Administrate insurance websites, oversee passwords.
• Collect insurance referrals and prior authorization for testing and procedures. Authorize and manage Neuro Psychiatric Testing. Ensure the approvals for the authorizations are in the EMR and CERNER systems.
• Promote department goals by training team members on insurance policies. Stay current on guidelines set by insurance. Educate staff and providers on insurance policies.
• Act as a resource with regards to insurance and coding policies and procedures to both staff and providers.
• Act as liaison and problem solver between physician and staff with regards to coding and charge entry.
• Provide resolution to coding related issues based on industry coding best practices.
• Analyze, code and abstract information for the purpose of assigning and entering appropriate and consistent diagnoses and procedure codes for reimbursement.
• Resolve discrepancies on coding related issues.
• Analyze and understand reasons for denials.
• Document trends of denials to share with department, and provide in‑service for continuous improvement. This includes changes of internal system, carrier updates, functions, and duties & processes impacting billing cycles.
• Inform staff and self‑pays of UH financial aid applications and Medicaid applications.
• Ensure all data are accurately documented in the EMR and scanned into CERNER.
• Provide data to CPMP Patient Accounts as requested for patient inquiries.
• Initiate Source Document to add new CPT Codes to Patient Keeper and Cerner.
• Proactively identify and implement opportunities for process improvements.
• Attend meetings and all other duties as assigned.

Required Education & Qualifications:

• Associate’s degree; in lieu of degree, an additional 2 years of experience working in a physician practice or healthcare environment.
• Three (3) years of full‑time experience working in a physician practice or healthcare environment.
• Knowledge of insurance verification/update, scheduling, assist with prior pre‑authorization or obtaining referrals process experience.
• Strong organizational and communication skills (both verbal and written).
• Excellent attention to detail.
• Exceptional telephone etiquette.
• Proficient in Microsoft Office.

Preferred Qualifications:

• Bachelor’s Degree.
• EMR experience - Cerner/IDX.
• Experience with patient scheduling.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee must be able to communicate with patients, staff and medical providers. This position is largely sedentary and requires the employee to remain stationary for a majority of the day. Any additional physical demands will be outlined and provided by management.

The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of CPMP.

CPMP provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity or expression, or any other legally protected status. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall and transfer, leaves of absence, compensation and training.

CPMP expressly prohibits any form of workplace harassment based on race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status. Improper interference with the ability of CPMP’s employees to perform their job duties may result in discipline up to and including discharge.