Prior Authorization

Published June 7th, 2024

Temp: Start end of June thru August
Hours: Monday – Friday, 8:00am-4:30pm
Pay: $25-$28, flexible
Location: Training onsite in Boston, fully remote after training
Job Description

GENERAL SUMMARY/ OVERVIEW STATEMENT:

Responsible for obtaining appropriate insurance authorizations, referrals and payments for all patient visits and procedures as well as collection of patient service coinsurance, deductibles and self-pay revenue.  There is a high level of direct or phone patient/physician interface.
 

PRINCIPAL DUTIES AND RESPONSIBILITIES: 
  • Verifying insurance eligibility, benefits and ensuring and/or reviewing referral reports to verify active referrals on file for each patient visit.
  • Completing and (upon physician approval) physician treatment plans in their entirety and accurately to insurance companies in order to obtain financial clearance.
  • Responsible for identifying and collecting payments for non-covered patient service revenue which includes but is not limited to past due balances, non-covered services; deductibles and coinsurance.  
  • Responsible for correct and accurate posting in the billing system of collected patient service revenue. 
  • Explaining insurance coverage to patients, advising patients; requires detailed knowledge of insurance requirements and close attention to patient scheduled appointments since each insurance company has different requirements.
  • Ensuring patients have signed self-pay waivers and contracts when appropriate, understand the refund process. 
  • Ensuring signed documents are scanned into the electronic filing system. 
  • Explaining fee structures to patients for various treatment options and all other special programs.
  • Responsible for the centralized surgical billing calendar. Obtaining prior authorization for all surgeries on the PO side, as well as obtaining any facility authorizations the insurance company will provide.
  • Responsible for handling all patients’ billing problems and inquiries, and working with and triaging to the Billing, Compliance and Education team to resolve problems.
  • Responsible for ensuring insurance referrals are received which may include working with the patient’s primary care physician or patient to obtain a referral, educating secretarial staff regarding which services are and are not covered by each insurance plan and which require a referral
  • Receives and expedites all incoming/outgoing telephone calls in a professional and courteous manner.   

 

QUALIFICATIONS:              
  • Customer service experience, required
  • College degree, preferred – or years of equivalent experience will be considered
  • 1-3 years’ experience in health care setting and extensive knowledge of 3rd party payers and billing requirements, preferred

 

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:           
  • Excellent interpersonal skills
  • Excellent written and oral communication skills
  • Accuracy, with attention to detail
  • Math/Financial experience
  • Ability to work both independently and as part of a team
  • Computer skills, including word processing and data entry
  • Ability to work under pressure, multi-task and meet deadlines
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