Authorization Specialist/ Medical Collection

SA PAIN CLINIC; San Antonio (TX); On-site; USD 42,000 - 66,000; Full time

Job summary

SA Pain Clinic is seeking an Insurance Verification Specialist to manage patient insurance coverage, verify authorizations, and maintain accurate insurance data. You will coordinate with staff to ensure smooth billing operations and protect patient confidentiality.

The role focuses on verifying coverage, updating accounts, and escalating any authorization needs while communicating effectively with providers and insurance companies.

Responsibilities

• Verify insurance coverage for new patients and re-verify for existing patients monthly.
• Update patient accounts with corrected insurance information.
• Determine if authorization is required and obtain it when needed.
• Maintain up-to-date information on insurance companies and changes.
• Communicate important insurance data to staff.
• Review procedure requests for authorization to prove medical necessity.

Job description

Job Description Verify insurance coverage for potential new patients and re-verify insurance coverage for existing patients every monthUpdate patient computerized accounts with corrected insurance information.Determine if authorization is required for ordered services, if authorization is required, obtain authorization from insuranceMaintain up to date information on various insurance companies and any relevant changes.Communicating important insurance data to appropriate staff.Reviews procedure requests for authorization needed based upon insurance standards while drawing upon experience and general knowledge. Reviews documentation or contacts the provider when necessary to supplement the order to prove medical necessity.Ensures appropriate documentation is available and complete before submitting the authorization to the insurance company to avoid repetitious submissions and denials.Submits all authorizations with correct CPT and diagnosis codes.Cross-references the procedure tasked against the doctor’s orders to ensure all services are submitted for correctly.Enters any authorization numbers and expiration dates into the task messages which are required for corresponding services.

• Schedule new patients
• Work patient balances weekly from practice schedule, send patient balances to receptionist and medical assistants
• Collect balances from patient/ make payment arrangements with patientsPerform follow up with insurance companies on unpaid insurance accounts identified through aging reports.
• Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Supervisor.
• Process appeals
• Process billing calls and questions from patients and third party carriers.
• Analyze and interpret that claims are accurately sent to insurance companies.
• Answer/respond to correspondence related to patient accounts.
• Communicate daily with internal and external customers via phone calls and written communications.
• Research, record findings, and communicate effectively with Manager to achieve optimum performance.
• Pursues and participates in education to remain current with changes in the Healthcare industry.
• Maintains patient confidence and protects medical office operations by keeping patient information confidential.
• Other duties/tasks as assigned