Medical Insurance Authorization Agent

SUMMARY/OBJECTIVE:

Responsible for obtaining authorization from insurance carriers for Behavior Health and Medical Procedures with Multiple locations.  Must have experience with health insurance medical policies as well as insurance carrier benefit structures and the processes to obtain authorizations

RESPONSIBILITIES/DUTIES OF THE INSURANCE AUTHORIZATION AGENT:

• Filing requests for prior authorization for all insurances that require based upon plan or insurance contract
• Must request, obtain, and document (within current software) all prior authorizations (or denials of same) appropriately and in a timely manner
• Assists as requested with collection activities on accounts involving prior authorization activity, including accepting phone calls related to prior authorization questions from other staff
• Coordinates with scheduling, back office, and front office on prior authorization activity
• Maintains the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
• Performs related work as required
• Works closely with agency to meet established timelines
• Works closely with and supports team efforts to accomplish authorization
• Requests authorization from insurance company case manager to provide specific services and parameters of care
• Adhere to all company policies and procedures
• Backup verification team when current team resource is not able to complete
• Check status of pending authorizations
• Other assigned duties

JOB SPECIFICATIONS:

• Experience and Knowledge in insurance pre-authorization processes
• Clear and thorough communication skills
• Must be well organized and detail oriented
• Proficient with Microsoft Office (Outlook, Work and Excel), Medical Practice
• Management and Billing Systems
• Insurance Denial Appeal Experience
• CRM experience (optional)
• Knowledge of ICD 10 coding-experience preferred
• Ability to establish and maintain effective working relationships with all segments of the branch staff, billing and collections department and, insurance representatives
• Self-Starter and able to work independently
• Ability to multi-task
• Usage of medical Terminology
• Computer literate and can learn new software programs
• Can use basic office equipment

REQUIRED EDUCATION/EXPERIENCE:

• 2-years Pre-authorization experience

ESSENTIAL FUNCTIONS:

Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Environment:

The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work)

Physical Demands:

Sedentary-Exerting up to 10 lbs of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects

Frequently: 46-100%

• Stooping, Kneeling, Crouching, Fingering, Grasping, Talking, Hearing, Repetitive Motion, Sitting

Occasionally: 16-45%

• Reaching, Standing, Walking, Pushing, Lifting, Driving

Vision

The worker is required to have close visual acuity to perform an activity such as: viewing a computer terminal and extensive reading

 

 

EEOC Disclosure:

Salience Health is an equal opportunity employer.  We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.