Az Asthma & Allergy Institute
Eligibility & Authorization Specialist
Az Asthma & Allergy Institute, Peoria, Arizona, United States, 85381
Position Summary
The primary function of the Eligibility and Authorization Specialistis to contact medical insurance carriers to ensure eligibility, priorauthorization and/or obtain referrals for all clinical services. Identifiesoutstanding patient financial responsibility by creating financial estimatesand notifying patients. This position is responsible for processing thefinancial clearance of each patient and ensuring successful payment of servicesrendered.
Reports To:
Eligibility and Authorization Specialist Supervisor
Principal Duties andResponsibilities Responsible for effective and efficient verification and authorizations of all patients' benefits. Utilization of electronic verification/eligibility technology or contacting insurance companies to verify and/or obtain patient eligibility and benefits. Verify existing patient insurance coverage and update the information in the practice management software system. Responsible for obtaining all referrals and authorizations for procedures and services, as required. Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected. Address rejected claims related to patient eligibility, authorization, or demographics. Responsible for answering incoming calls from other providers, recipients, and carrier groups in relation to insurance coverage. Ensures all patient questions are answered and issues are resolved timely by utilizing the appropriate resources. Develops and maintains effective relationships with the patients ensuring all patient demographic and insurance information is obtained and current. Maintain up-to-date knowledge of specific clinical services, registration, and pre-registration requirements for all departments. Maintain awareness of federal and state health care legislation and regulations, OSHA, and HIPAA. Proactively identifies and leads department process improvement opportunities. Maintain patient and company confidentiality. Other duties as assigned by the Eligibility & Authorization Specialist Supervisor and Revenue Cycle Director.
Required Skills, Knowledge,and Abilities Excellent organizational skills and the ability to multi-task. Ability to operate basic office equipment, answer multi-line telephones, and have a strong computer background. Establish and maintain effective working relationships with patients, insurance companies, and staff. Strong written and oral communication skills. Knowledge and skills in working with computerized billing systems including practice management software and EMR. Must adhere to all HIPAA guidelines and regulations. Knowledge of medical insurance and authorization processes Knowledge of medical terminology and experience working in a healthcare or insurance environment.
• Knowledge of organizational policies,procedures, and systems. • Ability to document electronically andaccurately. • Use appropriate guidelines for releasinginformation.
Education
High school diploma or equivalent
Experience
Must have 2 years of experience performing insuranceverification or working with medical insurance programs.
Experience with eligibility, verification of benefits, andprior authorizations from various HMOs, PPOs, commercial payers, and otherfunding sources.
Other Requirements
Must be a team player with a positive attitude.
Working Conditions
OSHA Category 3: Involves no regular exposure to blood, body fluids, or tissues, andtasks that involve exposure to blood, body fluids, or tissues are not acondition of employment. While performing the duties of this job, the employeeis regularly required to sit, talk, use repetitive motion, and type.
Az Asthma & Allergy Institute is an EEO employer - M/F/Vets/Disabled
The primary function of the Eligibility and Authorization Specialistis to contact medical insurance carriers to ensure eligibility, priorauthorization and/or obtain referrals for all clinical services. Identifiesoutstanding patient financial responsibility by creating financial estimatesand notifying patients. This position is responsible for processing thefinancial clearance of each patient and ensuring successful payment of servicesrendered.
Reports To:
Eligibility and Authorization Specialist Supervisor
Principal Duties andResponsibilities Responsible for effective and efficient verification and authorizations of all patients' benefits. Utilization of electronic verification/eligibility technology or contacting insurance companies to verify and/or obtain patient eligibility and benefits. Verify existing patient insurance coverage and update the information in the practice management software system. Responsible for obtaining all referrals and authorizations for procedures and services, as required. Responsible for acting as a liaison between patients, healthcare providers, and insurance carriers to ensure all proper measures are taken and information is collected. Address rejected claims related to patient eligibility, authorization, or demographics. Responsible for answering incoming calls from other providers, recipients, and carrier groups in relation to insurance coverage. Ensures all patient questions are answered and issues are resolved timely by utilizing the appropriate resources. Develops and maintains effective relationships with the patients ensuring all patient demographic and insurance information is obtained and current. Maintain up-to-date knowledge of specific clinical services, registration, and pre-registration requirements for all departments. Maintain awareness of federal and state health care legislation and regulations, OSHA, and HIPAA. Proactively identifies and leads department process improvement opportunities. Maintain patient and company confidentiality. Other duties as assigned by the Eligibility & Authorization Specialist Supervisor and Revenue Cycle Director.
Required Skills, Knowledge,and Abilities Excellent organizational skills and the ability to multi-task. Ability to operate basic office equipment, answer multi-line telephones, and have a strong computer background. Establish and maintain effective working relationships with patients, insurance companies, and staff. Strong written and oral communication skills. Knowledge and skills in working with computerized billing systems including practice management software and EMR. Must adhere to all HIPAA guidelines and regulations. Knowledge of medical insurance and authorization processes Knowledge of medical terminology and experience working in a healthcare or insurance environment.
• Knowledge of organizational policies,procedures, and systems. • Ability to document electronically andaccurately. • Use appropriate guidelines for releasinginformation.
Education
High school diploma or equivalent
Experience
Must have 2 years of experience performing insuranceverification or working with medical insurance programs.
Experience with eligibility, verification of benefits, andprior authorizations from various HMOs, PPOs, commercial payers, and otherfunding sources.
Other Requirements
Must be a team player with a positive attitude.
Working Conditions
OSHA Category 3: Involves no regular exposure to blood, body fluids, or tissues, andtasks that involve exposure to blood, body fluids, or tissues are not acondition of employment. While performing the duties of this job, the employeeis regularly required to sit, talk, use repetitive motion, and type.
Az Asthma & Allergy Institute is an EEO employer - M/F/Vets/Disabled