Eligibility and Authorization Specialist - Los Angeles, United States - Regroup

Description

Responsibilities

• This role works directly with patients, insurance companies, and clinical departments to verify insurance coverage, obtain proper authorizations.
• Determines deductibles, copayments, coinsurance, CPT and Diagnosis/Procedure Codes, Medical policies, LCD s and Medical terminology.
• Reviews physician orders for medical necessity and accuracy and provides clinical documentation to support proper authorization.
• Provide patient education of service benefits, status of pending or denied authorizations and for limited benefit coverage.
• Accurately enters insurance benefits and authorization information into patient accounts.
• Effectively working with insurance companies, with extensive amount of time on the telephone.
• Provide timely responses to voicemail and email inquiries to the verification team.
• Provide feedback to staff of patient benefits/authorization in a timely manner.
• Assist with submission appeals and follow up with unpaid claims.
• Create patients statements.
• Performs other duties as assigned.

Qualifications

• We are looking for an individual with at least 1 year of knowledge and experience in Insurance benefits verification, Authorization requests, and referral requests for Medicare, PPO, HMO, and IPA insurances.
• Positive, caring attitude, and self-motivated to do whatever is necessary to provide.
• Outstanding patient service and do whatever is needed to ensure effective operations.
• Basic level skill in Microsoft Excel, Word, and outlook.
• Can multitask, prioritize, and manage time effectively.
• Have Impeccable attention to detail.
• Enjoys working both independently and collaboratively as part of a team.
• Open to learn and improve skills.
• High school diploma is required.