Insurance Auth Spec

Lincare Holdings; Texarkana (TX); On-site; USD 36,000 - 48,000; Part time

Job summary

Lincare Holdings is seeking an Insurance and Authorization Specialist to obtain benefits and eligibility information and submit authorizations 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.

The role involves running eligibility, contacting insurers, reviewing documentation for completeness, and

Qualifications

• High school diploma or GED or equivalent required.
• Medical billing/coding experience preferred.
• Health insurance authorization submission experience and computer entry skills required.

Responsibilities

• Run eligibility and benefits checks.
• Call insurance to review HCPCs and policies.
• Analyze documents to ensure required items are present and patient qualifies.
• Coordinate with centers or providers for additional documentation.
• Review paperwork for completion and accuracy.
• Submit authorizations and follow up on approvals.
• Attach documentation to the EMR with systematic naming.
• Input thorough notes in the EMR and communicate with centers.

Education

High school diploma or GED

Medical billing/coding experience

Health insurance authorization submission experience

Computer entry experience

Tools

EMR system

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 preferredComputer entry experience necessary

Physical Demands:

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