Insurance Auth Spec

About the role

Obtain benefits and eligibility information and submit authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements. Part-Time positions offer a minimum of 17.5 hours and a maximum of 35 hours per week, with potential week-to-week fluctuations if desired.

Responsibilities

• Run eligibility and benefits checks with insurance providers.
• Call insurance to review individual HCPCs and policy details.
• Analyze paperwork to ensure all required documentation is received and the patient qualifies under insurance guidelines.
• Work with the local center or referring provider to obtain additional documentation if 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 the local center regarding the authorization process.
• Use critical thinking and payer knowledge to determine appropriate authorization dates for existing patients.
• Obtain re-authorization paperwork 30-45 days before expiration.
• Request authorizations 7-14 days before expiration, guided by reports from the Supervisor.
• Assist in calling 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 co-workers.
• Conduct in-depth reviews to obtain eligibility and correct information for complex payers.