Patient Benefits Specialist / Prior Authorization Specialist
: Job Details :

Position SummaryThe Patient Benefits Specialist is responsible to obtain pre-authorizations/pre-certifications as required by insurers for upcoming procedures, special testing, and referrals, and contacts patients prior to services to discuss insurance coverage and financial responsibility.Essential Job Functions and Responsibilities* Obtains pre-authorizations/pre-certifications as required by health insurers or managed care providers for upcoming procedures, radiology or diagnostic testing, laboratory or other special testing.* Works with reception and clinical staff to coordinate referrals to outside facilities or providers.* Verifies Medicare, Medicaid and health insurance eligibility prior to upcoming services and procedures.* Contacts patients prior to appointment or procedure to discuss insurance coverage and benefits and patient financial responsibility.* Informs Patient Account Representatives of new or different insurance plans for patients, in case claims need to be resubmitted to the correct payer.* Works with clinical staff to manage appointment frequency, insurance coverage and benefits for patients on infusion therapy.* Maintains up-to-date knowledge of clinical guidelines, precertification requirements, and medical policies for services and procedures by routinely reviewing payer newsletters, regulatory and payer websites, and professional periodicals.* Acts as administrator for the insurance websites and obtains and maintains logon access to all payers' websites.* Performs other duties as assigned.Minimum Qualifications* Education* High school diploma or equivalent required.* Licensure/Certification* Advanced training/certification in medical billing, coding, and/or insurance preferred.* Experience* Minimum of one-year experience in a medical billing role is required, or equivalent education.Competencies Required* Knowledge* Working knowledge of medical and insurance terminology.* Basic knowledge of medical and insurance terminology, CPT, HCPCS, and ICD-10 coding.* Skills* Possesses interpersonal, communication, and listening skills necessary to deal effectively and courteously with patients and all staff members.* Proficient computer skills working in an Electronic Medical Record (EMR) and Practice Management software, and Microsoft Word, Excel, and the Internet.* Demonstrates professionalism and respect in all forms of communication and correspondence.* Abilities* Ability to maintain strict confidentiality of fiscal and health information.* Ability to work in a fast paced, multi-tasking environment and cope with rapidly changing demands while working as a team member.* Ability to prepare and gather information accurately and efficiently.