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Pre-Authorization Specialist

at Spectrum Healthcare Partners in Portland, Maine, United States

Job Description

Company Overview

Spectrum 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 , flexible hours between 7:30 AM – 5:00 PM. Partially remote/hybrid schedule possible after training. 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

PRIMARY RESPONSIBILITIES

+ Assists AR Representatives as necessary with resolution of denied claims including appeals of denied claims

+ Maintains patient confidentiality according to state and federal and company regulations.

+ Actively supports departmental and corporate strategic plans

+ Maintains productive and cooperative working relationships with others in the department and organization

+ Provides coverage for other revenue cycle staff members on an as needed basis.

+ Attend meetings, as assigned, and participate in educational activities to keep skills up to date

+ Demonstrate professionalism always

+ Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues

+ Displays cooperative behavior and interacts positively and effectively with others to promote a team environment.

+ Support the Company’s Vision and Values

+ Performs other duties necessary to maintain the overall efficiency and continuity of the clinic/practice.

QUALIFICATIONS

+ High school diploma

+ 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

+ 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

PHYSICAL DEMANDS / WORK ENVIRONMENT

+ Operation of various office equipment; fax machine, telephone & voice mail system, stationary/lap top computer, scanner, e-mail system, cell phone, pager, and copier – data entry and typing

+ Light lifting of paperwork, folders or other general record keeping materials

+ May be required to sit or stand for extended periods of time

+ Occasional reaching, bending

BENEFITS AND PERKS

+ Health Insurance (80% company paid)

+ Dental & Vision Insurance Plans

+ 401(k) Match and Profit Sharing Plan

+ Life and Accidental Death and Dismemberment Insurance

+ Long-term Disability Insurance

+ Short-term Disability Insurance

+ Generous paid time off

+ Voluntary, Employee-Paid Benefits

+ Medical Reimbursement Plan

+ Dependent Care Plan

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Job Posting: JC212386425

Posted On: May 04, 2022

Updated On: Jun 30, 2022