Insurance Authorization Specialist

Granville Medical Center; Oxford (NC); On-site; USD 22,000 - 36,000; Full time

Job summary

Granville Medical Center is seeking an Insurance Authorization Specialist to work with Surgical/Referral Coordinators at referring practices to obtain pre-authorizations from patients' insurance plans.

You will coordinate with practice sites to collect patient payments prior to scheduled surgery dates and ensure accurate billing records.

Qualifications

• Experience in a medical billing environment.
• Experience obtaining pre-authorizations from insurers.
• Experience communicating about patient financial obligations.

Responsibilities

• Manage incoming and outgoing calls daily.
• Obtain pre-authorizations via insurer websites.
• Maintain pricing and identify patient vs. insurance portions.
• Explain to patients why payments are required before surgery.
• Update demographics and insurance information for primary/secondary coverages.
• Document payments in patient accounts.
• Collaborate with Surgical Coordinators across locations to resolve insurance and payment issues.
• Correct patient records to ensure future claims accuracy.
• Adjust to schedule changes and high-volume workflow.
• Communicate collection-impact information to insurers or patients.
• If needed, serve as patient services representative and cashier.

Skills

Medical billing

Insurance pre-authorizations

Patient communication

Time management

Prioritization

Meditech learning

Education

High school diploma or GED

Tools

Meditech

Job description

The Insurance Authorization Specialist will work with the Surgical/Referral Coordinators at our referring practice locations to ensure that pre-authorizations are obtained through the patient’s insurance company. This GHS associate will coordinate with the practice locations to collect payments from the patient prior to the scheduled surgery date.

Duties Include:

• Manage incoming and outgoing calls on a daily basis.
• Utilize insurance company websites to obtain pre-authorizations in the most efficient manner.
• Maintain accurate pricing, separately identifying patient portion/insurance portion for surgical procedures performed at the hospital
• Communicate to the patient the reason that they are required to make these payments prior to surgery.
• Make necessary changes to the patient's demographics and insurance information to obtain payment from the appropriate insurance company for both primary and secondary coverages.
• Accurately document payments in the patient accounts.
• Effectively work with Surgical Coordinators at multiple practice locations to overcome any challenges with the patient’s insurance, surgery schedule, and all applicable payments, both patient and insurance, required prior to surgery.
• Make corrections as needed to the patient’s electronic record so that future insurance claims and statements are accurate.
• Prioritize high volumes of work and make necessary adjustments in daily work activities to keep up with any changes to surgery schedules, and volume changes.
• Communicate effectively and accurately any information that impacts the practices ability to collect for services either from the insurance company or the patient.
• When needed, will also cross-function as a patient services representative and cashier.

QUALIFICATIONS

• High school diploma or GED equivalent required.
• Experience working in a medical billing environment and prior experience working with insurance companies to obtain pre-authorizations, coding experience preferred..
• Experience communicating with patients about their financial obligations.
• Understanding of co-insurance and deductibles.
• Excellent time management skills to be able to handle a high volume of both incoming and outgoing calls effectively every day.
• Ability to prioritize.
• Ability to learn a medical billing system and other related automated systems. Meditech experience preferred but training is provided.