Medical Insurance Verification & Authorization Expert

joinbetter.com; Birmingham (AL); In loco; USD 25.000 - 36.000; Part-time

Descrizione del lavoro

joinbetter.com seeks an Insurance Verification & Authorization Specialist to support revenue cycle and patient intake. You will verify insurance eligibility, review benefits, and determine authorization or PCP referral requirements.

Strong attention to detail and communication are essential for coordinating with insurers, provider offices, and internal teams. On-site in Birmingham, AL, the role requires experience in medical insurance verification, authorizations, and PCP referrals, with a focus

Competenze

• Previous hands-on experience in the medical field is required.
• Must be available to work on-site in Birmingham, AL, for a minimum of 30 hours per week.
• Experience with medical insurance eligibility and benefits verification.
• Experience checking and obtaining prior authorizations.
• Experience submitting PCP referrals and following up with provider offices.
• Knowledge of commercial insurance and government healthcare plans, such as Medicare and Medicaid.
• Understanding of in-network benefits, deductibles, coinsurance, referral requirements, and authorization processes.
• Strong organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Ability to manage multiple requests and follow up on outstanding items without constant supervision.
• Proficiency with computers, spreadsheets, and electronic documentation systems.
• Ability to handle confidential patient information in accordance with HIPAA requirements.

Mansioni

• Verify patients' insurance eligibility and active coverage.
• Review insurance benefits including deductibles, copayments, coinsurance, and out-of-pocket expenses.
• Confirm in-network and out-of-network benefits and provider participation.
• Identify coverage limitations, exclusions, and payer-specific requirements.
• Determine whether prior authorizations or PCP referrals are required.
• Document verification results accurately in the appropriate systems.
• Communicate insurance findings and potential patient financial responsibilities to internal teams.
• Review policies to determine prior authorization requirements for services, supplies, or DME.
• Submit authorization requests with required documentation.
• Follow up with insurance companies and utilization management departments regarding pending authorizations.
• Track authorization status, approval dates, expiration dates, and approved service periods.
• Identify missing documentation or additional information needed to complete authorization requests.
• Escalate delayed, denied, or urgent authorization requests as needed.
• Maintain accurate records of authorization submissions, follow-ups, and payer responses.
• Communicate authorization updates and requirements to internal departments.
• Verify whether a patient’s plan requires a referral from their PCP.
• Contact PCP offices to request and obtain required referrals.
• Submit referral requests and supporting documentation according to payer requirements.
• Follow up with provider offices and insurance companies on outstanding referrals.
• Track referral submission dates, approval status, effective dates, and expiration dates, when applicable.
• Resolve referral issues, including missing information, incorrect provider details, and processing delays.
• Ensure referrals are documented and available before proceeding with applicable services or orders.
• Maintain accurate and timely documentation in electronic systems.
• Manage assigned work queues and prioritize pending requests based on urgency and aging.
• Communicate professionally with insurance representatives, medical offices, and internal teams.
• Follow established workflows and payer-specific guidelines.
• Identify recurring insurance, authorization, and referral issues and report them to management.
• Protect confidential patient information and comply with HIPAA requirements.

Conoscenze

Insurance verification

Prior authorizations

PCP referrals

HIPAA compliance

Attention to detail

Strumenti

EHR systems

Practice management systems

Ticketing/CRM platforms

Descrizione del lavoro

joinbetter.com seeks an Insurance Verification & Authorization Specialist to support revenue cycle and patient intake. You will verify insurance eligibility, review benefits, and determine authorization or PCP referral requirements.

Strong attention to detail and communication are essential for coordinating with insurers, provider offices, and internal teams. On-site in Birmingham, AL, the role requires experience in medical insurance verification, authorizations, and PCP referrals, with a focus