Insurance Auth Spec

About the role

This position is responsible for obtaining benefits and eligibility information and submitting authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements. For Part-Time roles, hours will range from 17.5 to 35 per week with potential week-to-week fluctuation.

Responsibilities

• Run eligibility and benefits checks with insurance providers.
• Call insurance to verify individual HCPCs and policy details.
• Analyze paperwork to confirm all required documentation is received and the patient qualifies under insurance guidelines.
• Collaborate with local centers or referring providers to obtain additional documentation when needed.
• Review paperwork for completion and request authorization.
• Follow up on authorization status and attach all documentation to the EMR system using a systematic naming process.
• Input thorough notes in the EMR system.
• Communicate with local centers regarding the authorization process.
• Use critical thinking and payer knowledge to determine appropriate authorization dates for existing patients.
• Initiate re-authorization paperwork 30-45 days before expiration.
• Request authorizations 7-14 days before expiration, guided by reports from the Supervisor.
• Assist in contacting centers for missing information or corrections.
• Answer phones and respond to email inquiries from centers.
• Work on denials received and collaborate with RBCO to resolve insurance issues.
• Communicate professionally with patients, medical professionals, and coworkers.
• Conduct in-depth reviews to obtain eligibility and correct information for complex payers.