Insurance and Authorization Specialist - Clinic - Tulsa

MINIMUM QUALIFICATIONS

Education- A High School Diploma or GED equivalent is required. Completion of a program or training in Medical Office Technology or a related field is preferred.

Experience – A minimum of one (1) year relevant experience in customer service, healthcare settings, or related fields is preferred.

Licenses & Certification –

Knowledge & Skills –

1. Communication: Strong verbal and written communication skills to interact with patients and staff.

2. Customer Service: Empathy and patience to handle patient inquiries and concerns.

3. Computer Skills: Proficiency in using electronic records systems and other relevant software.

4. Medical Terminology: Knowledge of basic medical terminology to accurately communicate patient information.

5. Attention to Detail: Accuracy in recording and verifying patient information.

6. Problem-Solving: Ability to handle patient inquiries and resolve issues.

7. Time Management: Ability to manage a busy schedule and prioritize tasks effectively.

8. HIPAA Compliance: Understanding of HIPAA regulations and patient privacy.

JOB SUMMARY

Specialist serves as the front-line for patient interaction within a healthcare facility, managing check-in/out processes, insurance verification, authorization and scheduling appointments. They gather patient information, answer questions, and ensure a smooth and efficient patient experience.

WORK ENVIRONMENT

Work is performed in a hospital and ambulatory health care setting. Risk of exposure to infections disease does exist.

PHYSICAL DEMANDS

Performance of duties requires being seated for long periods entering data and requires the demands of normal office work.

ESSENTIAL FUNCTIONS

Satisfactory job performance will be determined by successful execution of the following:

1. Responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving and processing physician orders, obtaining necessary authorizations, while providing excellent customer service. Schedules and confirm patient appointments. Coordinates with medical staff to ensure timely and efficient scheduling. Manages appointment cancellations and rescheduling as needed. Operates the telephone to relay incoming calls as applicable. Adheres to policies and provide excellent customer service in these interactions with appropriate level of compassion.

2. Responsible for pre-registration, authorization, and patient accounts prior to patient visits. May include incoming and internal calling to obtain demographic, insurance, and other patient information, including the patient financial liability, authorization and collecting point of service collections.

3. Explains general consent for treatment forms to the patient/ guardian/guarantor/legal guardian, obtains necessary signatures and witness’s name. Explains and distributes patient education documents, such as Important Message for Medicare, MOON form, Consent forms, and all forms implemented for future services.

4. Reviews eligibility responses in the insurance verification system (EPIC), and appropriately selects the applicable insurance plan code, enters benefit data into system to support point of service collections and billing processes to assist with a clean claim rate.

5. Responsible for accurate screening of medical necessity using Advanced Beneficiary Notice (ABN) software to inform Medicare patients, if possible, non-payment of test by Medicare and distribution of the ABN as appropriate. Responsible for distribution and documentation of other design designated forms and pamphlets.

6. Effectively manage time and prioritize tasks to maximize productivity.

7. Provides support to colleagues to foster a positive work environment.

8. Consistently adheres to all department policies and procedures.

9. Collaborates seamlessly with other revenue cycle teams to address and resolve issues while delivering a high-level, personalized service within the defined team scope.