Authorization & Cost Estimate Specialist

Apex Systems; Norwood (OH); On-site; USD 24,796 - 27,552; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with company match

Job summary

A reputable service organization based in Norwood, OH is seeking a detailed and knowledgeable Authorization & Cost Estimate Specialist. The role involves collecting insurance information, determining costs for services, and communicating effectively with patients and medical professionals. Ideal candidates will possess deep knowledge of insurance plans, clinical services, and EHR programs, ensuring accurate coverage information is provided. This position offers a 6-month contract with potential for permanent hire, providing a supportive environment and various benefits.

Qualifications

• Expert knowledge of insurance plans and regulations is essential.
• Clinical knowledge to communicate effectively with insurance companies.
• Proficiency in EHR programs and medical terminology required.

Responsibilities

• Collect and analyze insurance information to authorize services.
• Determine cost for services based on patient benefits and coverage.
• Communicate effectively with patients and physicians to obtain necessary information.

Skills

Expert knowledge of insurance plans

Clinical knowledge of services

Knowledge of EHR programs

Proficient critical thinking

Detail oriented

Problem-solving

Excellent written communication

Exceptional time management

Conflict resolution

Team player

Tools

Microsoft Office

Epic

Job description

Authorization & Cost Estimate Specialist (Apex Systems)

Location: Norwood, OH (must be local to Norwood/Cincinnati area or surrounding regions)

Duration: 6‑month contract‑to‑permanent‑hire opportunity

Schedule: Monday–Friday, 8am–4:30pm

Pay: $18‑20 /hr on W2, weekly pay

Job Summary

• Collect insurance benefit and clinical information to authorize services.
• Determine cost for services by applying patient benefits/coverage information and estimate functionality via IT applications, ensuring patients understand financial responsibilities.
• Verify eligibility and benefits, determine coverage extent, secure pre‑authorizations, and calculate patient liabilities before appointments.
• Verify medical necessity per CMS standards and communicate coverage information to patients.
• Coordinate primary, secondary, tertiary liability; obtain pre‑certifications and pre‑authorizations from third‑party payers.
• Alert physician offices to insurance verification issues.
• Analyze insurance terminology and determine out‑of‑pocket liabilities.
• Connect patients with financial counselors, providing basic counseling when needed.
• Communicate with patients, physicians, clinicians, front‑end staff, translators to obtain missing information.
• Maintain excellent relationships with physicians’ offices, insurance companies, and hospital departments.

Skills & Qualifications

• Expert knowledge of insurance plans, regulations, benefits and coverage related to services.
• Clinical knowledge of services to communicate with insurance companies and ensure correct level of care.
• Knowledge of EHR programs (e.g., Epic), medical terminology, insurance plans and benefits.
• Proficient critical thinking, detail oriented, problem‑solving; excellent written and verbal communication.
• Exceptional time management, conflict resolution, and multitasking.
• Team player, works independently; proficiency in Microsoft Office.
• Professionalism, trustworthiness, honesty, integrity.

Preferred Skills & Experience

• Customer service and/or call center experience.
• 1+ year registration or insurance verification related experience.

Benefits

Apex offers supplemental benefits including medical, dental, vision, life, disability, and optional insurance plans. Additional programs: ESPP, 401(k) with company match, HSA, EAP, corporate discount savings, and professional development resources.

Apex Systems is an equal‑opportunity employer. We do not discriminate on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. (Include full EEO statement as required.)

If interested, email an updated resume to Melissa at [e-mail] (reference Job ID: 3013187).