Benefits Clerk, Sr. jobs in Longview, TX

Title: Benefits and Authorization Specialist 

Job Summary

The primary function of the Benefits & Authorization Specialist is verifying prospective patient’s insurance coverage and benefits, educating the company intake and billing teams of patient benefit information, obtaining pre-authorization for services from insurance payors, following up on authorization for service requests with payors, obtaining retroactive authorizations for services with payors, and maintaining authorizations for all new and existing patients until patient discharge occurs.

Job Qualifications

Education: High School Graduate (College Preferred).

Experience: One-year insurance verification and/or authorization experience strongly preferred.

Skills: Knowledge of medical terminology, intermediate computer skills, and attention to detail. Good interpersonal skills and an ability to establish and maintain effective working relationships with all segments of the staff.

Transportation: Reliable transportation. Valid and current auto liability insurance.

Environmental/Working Conditions: Performs duties either remotely or in an office environment during the Company’s operating hours (8:00am – 5:00pm). If remote, must have reliable high-speed internet access, and a working cell phone or landline (technology not reimbursed by company). Works in a routine office environment; noise level may be moderately high. Must have the ability to work during business hours and occasional extended hours as needed and requested by the manager.

Essential Functions Evaluation

1. Receives and appropriately verifies new referrals’ insurance benefits and authorization requirement in a timely manner.

2. Provide verified information to intake/clinical tram and Revenue Cycle Manager.

3. Requests authorization from payers, follow up on authorization request, manage and maintain authorization for all new and existing patients.

4. Provides effective communication to appropriate staff members, billing specialist, and Revenue Cycle Manager of changes to insurance coverage and or authorization for existing patient.

5. Uploads payor communication documents into the EMR, as needed, utilizing company guidelines for document naming conventions and attachment types.

6. Monitor and maintain assigned workflow.

7. Responds to company and billing team needs in a professional and timely manner.

8. Demonstrates commitment, professional growth, and competency.

9. Participates in Company sponsored in-service training.

10. Promotes the company culture, values, and mission by presenting a positive image to those we serve, including patients, families, physicians, vendors and community agencies in word, action, and appearance.