Insurance Auth Spec

externallincarecareers; Texarkana (TX); On-site; USD 25,000 - 36,000; Part time

Job summary

externallincarecareers is seeking an Insurance and Authorization Specialist in Texarkana, TX for a part-time schedule (17.5–35 hours/week). You will verify benefits and eligibility and submit authorizations for Enteral Nutrition or Oral Nutrition Supplements, ensuring timely renewals and accurate documentation.

The role involves calling insurers, reviewing patient records, coordinating with centers and providers, and maintaining EMR entries with precise notes and file naming conventions.

Qualifications

• High school diploma or GED with related experience and/or training.
• Medical billing/coding experience preferred.
• Health insurance authorization submission experience preferred.
• Computer entry experience necessary.

Responsibilities

• Run eligibility and benefits checks.
• Call insurance to review HCPCs and policies.
• Analyze documents to ensure required information is received and patient qualifies.
• Submit prior authorization and follow up on authorization.
• Attach documentation to the EMR with proper naming conventions.
• Input thorough notes in the EMR system.
• Communicate with centers and providers about authorization status.
• Manage re-authorizations 30–45 days before expiration and requests 7–14 days prior.
• Assist centers with missing information or corrections.
• Handle denials and collaborate with RBCO on insurance issues.

Education

High school diploma / GED

Tools

EMR systems

Job description

The Insurance and Authorization Specialist is responsible for obtaining benefits and eligibility information and submitting authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements. For Part-Time positions, the standard hours will be determined at hire with a minimum of 17.5 hours and maximum of 35 hours with potential week to week fluctuation if desired.

Job Responsibilities:

• Run eligibility and benefits
• Call insurance to go through individual HCPCs and Policy
• Analyze paperwork to ensure that all required documentation has been received and that patient qualifies under the insurance guidelines
• Work with local center or directly with referring provider if additional documentation is needed
• Review paperwork for completion
• Request authorization and follow up on authorization
• Attach all documentation to the EMR system via a systematic naming process
• Input thorough notes in EMR system
• Communicate with the local center on authorization process
• Use critical thinking skills and payer knowledge to determine what dates to submit for authorization for existing patients needing authorization
• Work on getting paperwork for re-authorization 30-45 days before expiration
• Request authorizations 7-14 days before expiration, will receive report from Supervisor
• Assist in calling centers for missing information or corrections
• Answer phones and email questions from the centers
• Works on denials received
• Work with RBCO to determine denials and insurance issues
• Communicate professionally with patients, medical professionals, and co-workers
• Spend time getting eligibility and correct information on payers that require a more in-depth review

• Read and analyze documents such as patient orders
• Comprehend pharmacy prescription terminology
• Effectively communicate with co-workers and patients alike
• Help with the training of employees
• Calculate figures and amounts in reference to frequency and doses dispensed
• Apply common sense understanding to carry out oral and written instructions

Education and Experience:

• High school diploma or general education degree (GED), related experience and/or training, or equivalent combination of education and experience
• Medical billing/coding experience preferred
• Health insurance authorization submission experience preferred
• Computer entry experience necessary

Physical Demands:

The employee must occasionally lift and/or move up to 10 pounds.