Medical Eligibility, Authorization, Referrals Specialist

Rimage Solutions; United States; Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a skilled Medical Back Office Eligibility, Authorization, and Referrals Specialist to join their Healthcare Services team. This remote position offers moderately flexible hours and requires a strong background in medical billing and back-office operations. The role involves verifying insurance benefits, processing medical records, and collaborating with team members across locations. Ideal candidates will have excellent problem-solving skills and proficiency in English. If you're ready to make a significant impact in healthcare services, this opportunity is for you.

Benefits

Work from home

Moderately flexible hours

Accrued PTO

Salary inclusive of all benefits

Specific job training

Structured annual review process

Qualifications

• Minimum 1 year experience in US medical billing industry.
• Knowledge of medical back-office operations and billing aspects.

Responsibilities

• Verify patients' insurance benefits and requirements.
• Process incoming and outgoing e-faxes in EMR system.
• Communicate with team members to resolve issues.

Skills

Eligibility Checks

Referral Authorizations

Medical Billing

Problem Solving

Communication Skills

Education

College Graduation

Tools

eClinicalWorks

Job description

Job description:
Medical Back Office Eligibility Authorization, Referrals Specialist
Rimage Solutions is an IT software and Services company based in USA. We are looking to hire an experienced and senior Medical Back Office - Eligibility, Authorization, Referrals Specialist for our Healthcare Services team. You can work from home with moderately flexible hours. We invite you to apply for this position if you own a decent computer system with good internet connection, a workspace that can provide you the privacy, intention to work hard, and the necessary minimum skills/experience in the areas mentioned below:

- Hands on experience in Eligibility Checks and Referral / Authorizations.
- Knowledge of Medical Records / Chart Prep is a plus.
- Knowledge of Medical billing, coding, and AR lifecycle.
- Making decisions, problem solving, and a knack for finding solutions are key in this role.
- Proficiency in spoken and written English is a must.
- Minimum 1 year experience in US medical billing industry.

If you do not have the strong and relevant experience in these fields, please do not apply as this is not an internship position, and we expect that you know the necessary aspects of USAs medical back-office operations. We encourage you to study our requirements below in detail before applying.

Compensation: Negotiable based on your experience and skills. If this opportunity excites you then feel free to apply and clearly indicate your compensation expectations.

How to be ahead of others: If you are confident that you have the skills and experience for this position, please email us at [e-mail] and attach a recent resume with details of prior work, any certifications that you may have, your LinkedIn profile link, and link to your VIDEO PROFILE. Describe on the video (in English) why we should hire you and not anyone else.

Roles and Responsibilities
1. Verify patients' insurance benefits and requirements.
2. Review patients' medical history and provide pertinent information for referral authorization requirements.
3. Follow up and secure authorizations prior to services.
4. Process incoming and outgoing e-faxes, and allocate to appropriate folders in EMR system.
5. Process Medical Record requests.
6. Communicate with other team members (In India and USA) to resolve issues.
7. Input patient information and update system if needed.
8. Clearly document all communications and contacts in patients chart.
9. Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
10. Assess and resolve inquiries, requests, and complaints to ensure those customer inquiries are resolved at the first point of contact.
11. Provide accurate product/ service information to the customer, research available documentation including authorization, nursing notes, record requests, medical documentation on client's systems, interpret explanation of benefits received, etc. in advance.
12. Report daily production logs.
13. Demonstrate and apply knowledge of medical terminology including HIPPA regulations.
14. Practice and adhere to the Code of Conduct philosophy Mission and Value Statement.
15. Provide regular status updates and daily work summary to supervisor.


Ancillary Duties and Responsibilities
•Exhibit professional excellence, teamwork, and integrity.
•Maintain a positive work atmosphere.
•Maintain production levels ensuring quality of work is above average.
•Maintain a better than average attendance score.
•Performs other duties and tasks as assigned, depending on work schedules and priorities.

Desired Candidate Profile
Our ideal candidate is one who knows the medical back-office operations, and aspects of medical billing (like ICD/CPT codes, insurance eligibility verifications, authorizations, referrals, record requests, etc.). Knowledge of electronic medical records systems like eClinicalWorks and experience in processing medical claims is a plus.

Education: College graduation is required; we care more about your experience, skills, proficiency in English and sincerity at work.

Work Shift and Hours: Mon - Sat; morning or afternoon India Day shift or Afternoon shift as assigned.

Perks and Benefits
- Work from home (morning or afternoon shift, as assigned to you)
- Moderately flexible hours
- Accrued PTO
- Salary inclusive of all benefits
- Specific job training
- Structured annual review process