Experienced Intake / Authorization Specialist

About the role

AIS Healthcare is seeking a Benefit Verification and Authorization Expert with at least 3 years of experience in intake and verification. This role is part of a dynamic team dedicated to enhancing the care experience for patients through quality products and services.

Responsibilities

• Thorough knowledge of processes for patient insurance eligibility and benefits for various payers such as Aetna, Cigna, BCBS, Humana, Worker’s Comp, Medicare, and Medicaid.
• Specific knowledge of Authorization processes including GAPs, Pre-determination, PCP Referrals, and Single Case Agreements.
• Accurate entry of insurance and authorization information into EHR systems according to Standard Operation Procedures.
• Follow-up on pending or expired authorizations, referrals as assigned.
• Review authorization denials for accuracy; initiate the appeal process until the case is overturned, appeal options are exhausted, or decision is made to discontinue the process.
• Document details of all calls according to Standard Operation Procedures of the department.
• Timely follow-up and response to all Quality Reviews.
• Recognize patients' rights and responsibilities and support them in performing job duties, respecting their privacy and confidentiality.
• Maintain strict confidentiality and adhere to HIPAA guidelines.
• Maintain knowledge of NDC numbers, metric quantities, and infusion supplies.
• Maintain a broad range of knowledge about insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
• Share knowledge with other staff members and work as a team member.
• Interact with others positively, respectfully, and considerately.
• Perform other job-related duties as assigned.

Qualifications

• A high school diploma or GED equivalent.
• 3-5 years of healthcare industry experience, with Home Infusion and Intrathecal Pain Management experience preferred.
• Ability to recognize, evaluate, and exercise good judgment in complex situations, and advise accordingly.
• Excellent verbal and written communication and relationship-building skills.
• Strong work ethic with personal qualities of integrity and credibility.
• Self-directed, detail-oriented, conscientious, organized, and able to follow through.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.

Benefits

AIS Healthcare offers a comprehensive benefits package including health, vision, and dental insurance, long-term disability insurance, life insurance, a vacation package, a 401K plan with a generous employer match, and a 100% work-from-home opportunity. Additionally, there is a growth opportunity within the company.

Pay

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Schedule

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Steps to Apply

To apply, complete the required Culture Index Candidate Assessment by copying and pasting the provided link into your browser and selecting the corresponding position for which you are applying. The assessment is brief, taking less than ten minutes to complete.

Why AIS Utilizes the Culture Index Assessment

AIS recognizes the importance of its employees in achieving the company's success. By using the Culture Index Candidate Assessment, they aim to find the best match for each position based on natural traits and skillsets.

How to Complete the Assessment

To complete the assessment, copy and paste the following link into your browser and select the corresponding position for which you are applying. (Only one assessment per candidate is required.)

Culture Index Candidate Assessment