Insurance Auth Spec

Key Responsibilities

• Obtain benefits and eligibility information.
• Submit authorization and subsequent re-authorization for patients requiring Enteral Nutrition or Oral Nutrition Supplements.
• Run eligibility and benefits checks.
• Call insurance companies to verify individual HCPCS and policy details.
• Analyze paperwork to ensure all required documentation is received and that the patient qualifies under insurance guidelines.
• Collaborate with the local center or referring provider if additional documentation is needed.
• Review paperwork for completion.
• Request and follow up on authorizations.
• 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.
• Utilize critical thinking skills and payer knowledge to determine appropriate dates for submitting authorizations for existing patients.
• Work on obtaining paperwork for re-authorization 30-45 days before expiration.
• Request authorizations 7-14 days before expiration, based on reports from the Supervisor.
• Assist calling centers with missing information or corrections.
• Answer phones and emails from centers with questions.
• Address denials received.
• Collaborate with RBCO to resolve denials and insurance issues.
• Communicate professionally with patients, medical professionals, and co-workers.
• Conduct in-depth reviews of payers requiring more detailed eligibility and information gathering.

Requirements & Tech Stack

• EMR system
• Payer knowledge
• Critical thinking skills

For Part-Time positions, standard hours will be determined at hire, ranging from a minimum of 17.5 to a maximum of 35 hours, with potential week-to-week fluctuation.