at Spectrum Healthcare Partners in Portland, Maine, United States
Company OverviewSpectrum Healthcare Partners is Maine’s largest multi-specialty, physician-owned and directed professional organization and is comprised of over 200 physicians practicing in the areas of anesthesiology, orthopedics, pain management, pathology, radiation oncology, radiology, and vascular & interventional services. Spectrum provides services at many of Maine’s hospitals throughout the state and in eastern New Hampshire. POSITION SUMMARY As part of the Revenue Cycle team, the Pre-Authorization Specialist is responsible for obtaining benefits, verifying insurance information and pre-authorizations for services from various insurance companies in a timely manner and appropriately documenting the information in the patient’s electronic medical record to ensure accurate billing and timely collection of outstanding accounts receivables. Monday – Friday 7:30 AM – 4:00 PM or 8 AM – 4:30 Option to work hybrid 3 days remote and 2 days in office Fully remote schedule in the future ________________________________________________________________________________________ ESSENTIAL FUNCTIONS
+ Verifies health insurance eligibility and obtains benefit information.
+ Reviews clinical documentation to ensure it supports the insurance requirements for approval.
+ Requests pre-authorization for procedures within 24 hours of receipt from the clinical staff, including all the information required by the insurance such as correct CPT and ICD10 codes and supporting clinical documentation.
+ Accurately update the patient’s medical record with actions taken on the request for pre-authorization.
+ Works with the provider when additional information is required.
+ Follows up on pending authorization requests in a timely manner.
+ Submits requests and appeals for denied services; worked collaboratively with clinical staff to ensure appeals are accurate and complete; involving the provider when necessary.
+ Acts as a liaison between patients, the providers and the health insurance to assist patients in understanding their financial responsibilities.
+ Communicates with patient prior to procedure to review benefits and provide an estimate of the patient’s financial responsibility resulting from the procedure.
+ Prepares waivers for patient signature when the authorization has been denied and patient wishes to proceed with having the procedure.Answer calls from providers, patients and insurance companies related to authorization/pre-certification requests QUALIFICATIONS
+ High school diploma or equivalent
+ Two or more years of medical billing or related revenue cycle experience
+ Knowledge of medical services coding & medical terminology
+ Knowledge of insurance carrier requirements and policies for pre-authorization of surgeries and other procedures
+ Coding certification helpful
+ Strong attention to detail
+ Oral and written communication skills
+ Capable of working under time constraints
+ Ability to plan, organize and prioritize job duties with minimal supervision
+ Experience with insurance web products
+ Proficient computer skills
+ Ability to maintain confidentiality
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