AUTHORIZATION AND ELIGIBILITY SPECIALIST

Come work for Marimn Health - voted one of the Best Places to Work in the Inland Northwest in 2018, 2019, 2020, 2021, 2022 AND 2023 and Modern Healthcare's Family Friendliest Employer in 2020!Fantastic benefits, flexible schedules, paid holidays and ability to choose vacation times!Your employer paid benefits include:Medical, Dental, Prescription, and Vision for employee and all legal dependents.401(k) plan with 5% employer match after 1 year of employment.Employer paid life insurance.Short and long term disability.Generous PTO with the ability to earn additional personal days.Please note that this position is in Plummer, ID. Carpool opportunities are available.QUALIFICATIONS:A high school diploma or GED is required. A minimum of one-year’s experience in a medical office or healthcare setting preferred. A minimum of one year’s experience working with state, federal or third-party payers required. This position requires a thorough understanding of multiple services’ benefits within the facility. A minimum of one-year prior experience working with a clinical electronic practice management and electronic health record system is required. Candidates must possess an understanding of all phases of patient eligibility, benefits and prior authorizations process. All applicants must have verifiable, successful records of the following: tenacity, customer service skills, ability to work independently, be detail oriented and good with people. An understanding of FQHC/Tribal billing requirements desired.ADA ESSENTIAL FUNCTIONS:Hearing: within normal limits with or without use of corrective hearing devices.Vision: adequate to read 12-point type with or without use of corrective lenses.Must be able to verbally interact with staff, clients and public.Manual dexterity of hands/fingers for writing and data entry.Able to lift up to 25 lbs.Standing 25-75% of the day.Walking 25% of the day.Pushing up to 25 lbs.Pulling up to 25 lbs.RESPONSIBILITIES:Maintains a positive peer relationship and performs as a team player.Plans and prioritizes to maintain a time and attendance record which complies with company policy.Provides excellent internal and external customer service assistance, providing knowledgeable and appropriate information to customers.Works independently in a very detail oriented manner and meets deadlines.Employee reports to work in a timely manner.Employee utilizes breaks and meal periods to care for personal business outside of the work area.Employee completes work assignments in a timely manner and appropriately exits the work area in a timely manner.Employee appropriately utilizes Time and Attendance for clocking in and out and schedules absences in advance when possible.Employee is available for scheduled work shifts regularly and communicates absence to supervisor in a timely manner.Review daily schedules to ensure insurance information is accurate and confirm that benefits will cover treatmentMonitor Phreesia copays, account balances, and ensures that deductibles are accurately reflected.Contact primary and secondary insurance companies to verify benefits, this should include co-pays, deductibles, benefit used, benefit available, including out-of-network coverage and limits.Thoroughly document insurance verification and communications.Go through new patient registration to verify patients’ coverage.Input new insurance information in Next Gen and Pioneer RX.Understand and explain insurance coverage to patientsTrain patient care coordinators on benefits, including adding insurances to the charts and understanding various coverage types.Obtain ABN’s for non-covered servicesResponsible for verifying and obtaining prior authorization for services, procedures, and devices offered by Marimn HealthCollaborate with VA payer to keep authorizations current and prevent authorizations from expiring.Collaborates with fellow team members in the Revenue department to ensure that all encounters contain accurate payer information and notifies the relevant staff member of patient benefits.Reviews patient statement reports for accuracy weekly.Print and mail patient statements weekly.Refers patients to the O&E department for assistance in exploring potential insurance coverage options.Refers patients to First Impressions for sliding fee program.Works with patients to establish affordable payment arrangements.Works with staff and clients to resolve issues regarding insurance, billing and payments.Maintains reports as required to assist with departmental of clinic needs.Understands HIPAA regulations and all federal, state, and local governmental requirements regarding billing and complies with the contractual requirements of third party payers.Understands the rules regarding confidentiality and follows those rules.Understands and follows clinic policies in all areas.Understands and is in compliance regarding the requirements of all grants and funding sources used by the clinic for clinical services.Participates in meetings, training and committees as required.Seeks training opportunities and maintains any certificates required to perform job duties.Keeps abreast of changes affecting third party payers.Other duties as assigned.PM22

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