Senior Medical Billing Specialist

Job Description

Responsibilities

Verify patient eligibility and benefits via portal and/or phone call, including collecting referral and authorization requirements, across multiple payers, states, insurance products, and specialties within customer SLAs.

Work closely with providers to collect accurate patient and medical records and communicate authorization decisions.

Expediently complete prior authorizations using insurance portals or calling insurers directly.

Ensure authorization is approved in a timeline manner by following up with insurers and providing additional information.

Be responsible for handling multiple prior authorizations simultaneously and create process to ensure top of the line performance.

Become a subject matter expert in prior authorization workflows for large insurers

Communicate effectively across multiple stakeholders.

Maintain strict confidentiality and adhere to HIPAA regulations in handling patient information.

Qualifications and Requirements

Strong understanding of insurance policies and medical billing processes including CPT coding.

Familiar with providers software, including Electronic Medical Record Systems (EMR/EHR) and Practice Management Systems (PMS)

Experienced with HMOs, PPOs, POSs, EPOs, Medicare, Medicaid. Understanding of each through the referral and authorization process.

Familiarity with navigating insurance portals.

Strong phone etiquette and customer service skills, experience calling insurers to collect benefits and confirm authorization status.

Strong work ethic to operate with urgency, work independently, be highly organized, detailed oriented and multi-task effectively.

Can work efficiently under deadlines.