Medical Authorization Specialist — PTO & 403b Benefits

Valley Health Partners; United States; Remote; USD 46.000 - 62.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision plans

403b Retirement Plan with companymatch

Paid Time Off

Employee Assistance Program

Tuition Reimbursement

Zusammenfassung

Valley Health Partners is seeking a detail-oriented Benefits and Authorizations Specialist to obtain approvals for surgical procedures, diagnostics, medications, and referrals, and to support billing for timely payment from insurers and patients.

The role requires knowledge of authorization protocols across health plans, HIPAA compliance, and utilization management. You will collaborate with physicians and office staff to verify medical necessity and determine patient financial responsibility.

Qualifikationen

• High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
• 1 year in a healthcare setting with insurance verification/authorizations can be substituted in lieu of specialized training.
• Knowledge of HIPAA and payer workflows is preferred.

Aufgaben

• Collaborates with physicians and provider staff to determine appropriate authorization based on medical necessity and treatment plan.
• Performs medical necessity checks to verify support for procedures and diagnoses.
• Ensures authorizations align with network policy and communicates any out-of-policy items to appropriate parties.
• Contacts insurance companies to obtain verification, benefits, and precertification for approval.
• Verifies additional clinical information and insurance authorizations/referrals as needed.
• Reviews schedules to ensure proper authorizations have been obtained before patient visits.
• Monitors accounts registered versus scheduled procedures to maintain compliance with benchmarks.
• Determines estimated patient financial responsibility using verification data and payer contracts.

Kenntnisse

Billing procedures

Payer reimbursement

HIPAA knowledge

Utilization management

Insurance benefits

Ausbildung

High School Diploma/GED with insurance, coding, billing or healthcare certificate programs

Jobbeschreibung

Valley Health Partners is seeking a detail-oriented Benefits and Authorizations Specialist to obtain approvals for surgical procedures, diagnostics, medications, and referrals, and to support billing for timely payment from insurers and patients.

The role requires knowledge of authorization protocols across health plans, HIPAA compliance, and utilization management. You will collaborate with physicians and office staff to verify medical necessity and determine patient financial responsibility.