Verification Authorization Associate

Role Summary

Verification/ Authorization Associates are responsible for verifying active insurance coverage, obtaining all necessary facility and specimen collection information to bill in accordance to CMS regulations as well as contacting insurance companies to secure preauthorization required for patients to receive our services and contacting facilities for Medical Records when necessary. We need individuals to ensure information obtained is complete and accurate, follow up on requests, and apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements.

Responsibilities

• Adheres to all company policies and procedures.
• Review all patient insurance information needed to complete coverage verification.
• Verifies insurance eligibility to ensure claims are billed accurately and in accordance to payer guidelines.
• Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
• Responsible for prior authorization submissions and management.
• Maintains compliance with HIPAA and other healthcare regulations.
• Obtains medical records from facilities when necessary.
• Provides all information to the payer including medical record information and/or letter of medical necessity for determination of benefits.

Qualifications

• High School degree or equivalent required.
• 6+ Months experience in medical office setting.
• Proficient in MS Office (Word, Excel, Outlook).
• Must be highly organized with a strong attention to detail.
• Demonstrates solid time management skills and organization.
• Flexibility and ability to handle and manage frequent changes effectively and efficiently.
• Basic knowledge of insurance processing, guidelines and general laws related to all payers.
• Basic knowledge of clinical documentation review for alignment with insurance authorization requirements.
• Basic knowledge of CPT, ICD-10.
• Meets productivity/performance standards as set forth by management.

Preferred Qualifications

• Prior experience working with Insurance providers in a payor setting.
• Professionalism, superior organizational and communications skills; ability to educate and influence; strong follow-up and problem resolution mindset.
• Drive for Results ‚Äì Ensure procedures and processes lead to quality results and continual improvement.
• Communication ‚Äì Proficient verbal and written communication skills.
• Teamwork ‚Äì Commitment to achieving team and organizational goals.
• Customer Service Focus ‚Äì Focus on understanding client/customer needs and exceeding expectations.

Education

• Not specified beyond required in Qualifications.

Additional Requirements

• Physical Demands: Sit/stand for long periods; repetitive motion; lift up to 15 pounds; desk/cubicle environment.
• Training: All job-specific, safety, and compliance training as assigned.
• Other: Willingness to work shift work and overtime; occasional weekends/evenings/holidays.