Job Description

Job Description

Summary: The Benefit Verification Specialist-Authorization Specialist, under the direction of the Benefits Manager or Supervisor, initiates, obtains, and/or validates all necessary referrals, notifications, pre-certification and/or authorizations for scheduled services. This position will support our Shared Services Center and client hospitals around the country for a wide variety of payors, service lines, and patient types by providing top-notch support to the entire revenue cycle.

Essential Duties and Responsibilities: (List in order of importance or percentage of time spent on the particular responsibility. High to Low)

1. Initiate/obtain/validate all necessary referrals, notifications, pre-certification, and/or pre-authorizations for scheduled services. (40%)
2. Verify that documents are valid for the scheduled service being performed, date of service, and the correct facility. (20%)
3. Identify pre-authorizations/pre-certifications/referrals that are not valid and contact insurance payors to verify/validate requirements to ensure accuracy and avoid potential denials. Further, contacting ordering physician office, if necessary, to have the pre-authorization updated, resubmitted, or withdrawn. (10%)
4. Maintain effective communication with facilities, physicians, medical office staff, and all appropriate departments, utilizing department approved scripting. (10%)
5. Work with technology necessary to complete job effectively. This includes, but is not limited to, phone technology, applicable host systems, web applications, and scanning technology. (10%)
6. Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently met as well as the ability to perform all other duties as assigned or requested while adhering to strict deadlines. (10%)

Qualifications:

Required Education: High School Diploma or Equivalent

Required Experience: 1+ years of medical office or healthcare facility experience

Required License/Registration/Certification: None

Preferred License/Registration/Certification: Certified Professional Coder (CPC)

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of payer requirements and clinical information.

Computer Skills Required:

To perform this job successfully, an individual should have knowledge of host systems and payor web applications.

Physical Demands:

In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

The Employee is required to read, review, prepare and analyze written data and figures, using a pc or similar and should possess visual acuity.

The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.

The Employee is not substantially exposed to adverse environmental conditions and therefore job functions are typically performed under conditions such as those found in general office or administrative work.