Medical Benefit and Authorization Representative - Nashua, United States - Pain Solutions Management Group

Description

:

The Medical Benefits and Authorization Representative will serve as a Primary Financial Support Specialist to the practice's and the Ambulatory Surgery Center's patients.

This position will be responsible for verifying insurance eligibility and benefits, obtaining Pre-Authorization for applicable services (including, but not limited to surgical procedures and durable medical equipment), provide patients with Good Faith Estimates for future services, collect patient payments, assist in patient portal services, will act as the initial contact for any patient concerns related to billing, self-pay balances, insurance payments, and all other financial matters, and will review, edit, post and transmit daily billing claims.

KEY RESPONSIBILITIES:

Authorization Coordination

• Review patient's clinical record in order to complete the insurance authorization questionnaires
• Understand medical terminology, CPT and Diagnosis coding, as it applies to the patient's symptoms
• Initiate Insurance Portal authorization requests in a timely fashion
• Contact insurances to initiate authorizations when a portal is not available
• EHR reporting and maintaining Excel spreadsheets for tracking authorization statuses
• Keep timely communication with the clinicians regarding authorization denials and information needed
• Communicate with patients regarding the insurance policy and authorization determination

Insurance Benefits Coordination

• Provide patients with World Class Customer Service
• Contact insurance companies to obtain patient's eligibility, benefits and cost share for upcoming procedures and office visits
• Contact patients to inform them of their outofpocket responsibility prior to appointment
• Discuss payment arrangements set forth by our company policies, if necessary
• Explain and discuss insurance and practice policies for better patient understanding
• Educate patients about third party and insurance processes, their plan benefits, and how they affect patient balances

Patient Balance Collection

• Update demographic, insurance and guarantor information in the Patient Billing System.
• Discuss open, unpaid or overdue balances with patients
• Answer incoming patient phone calls and make outbound collection calls on open balances
• Set up payment plans, monitor and make outbound calls to patients with broken promise to pay agreements
• Advocate for patients and contact insurance companies on their behalf, when necessary, to resolve disputes
• Evaluate accounts from both an insurance and selfpay perspective for refunds or bad debt placement
• Troubleshoot and identify patient billing issues to resolve them to patient's satisfaction
• Interact with supporting departments; coding, cashops, AR follow up to resolve billing and payment issues
• Receive and process patient credit card payments, and allocate to appropriate visits on the account
• Post appropriate discounts and adjustments to patient accounts
• Assist with patients with access to the Patient Portal and password resets
• Other duties as assigned

Required Knowledge and Skill Sets:

• Act in a professional manner and treat patients, coworkers, and leadership with respect at all times
• Excellent organizational and time management skills
• Manage and work queues and worklists in patient billing system
• Maintain expected performance metrics
• Ability to communicate with others effectively in a concise manner, in order to bring issues effectively to a resolution
• Ability to think globally about the patient experience
• Knowledge of insurance rules/regulation and policies
• Professional Working Revenue Cycle experience
• Ability to bring tasks to completion in a satisfactory manner
• Ability to identify billing trends affecting patient balances
• Ability to evaluate situations and escalate issues appropriately
• Ability to multitask, and ability to follow through with our patients and contacts
• Ability to read, understand and interpret insurance Explanation of Benefits
• Experience with Excel, Word and Outlook required

Billing Claims Transmission

• Review billing claims for accurate coding
• Edit claims to ensure 100% accuracy of transmitted claims and reduce likelihood of claim denial
• Post claims via electronic data interchange
• Monitor transmission of claims in billing software to ensure claims are properly transmitted

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

Education:

Associates degree or relevant work experience required

Experience:

Medical billing, preferably in a professional setting, required

Software/Hardware:

Previous experience using electronic health record and/or electronic billing software required.


Benefits:

• 401(k)
• 401(k)

matching

• Health insurance
• Paid time off

Weekly day range:

• Monday to Friday

Experience:

• Insurance verification

:
1 year (preferred)

Work Location:

In person