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Prior Authorization & Eligibility Specialist

Finance | Waterford Township, MI | Full Time

Job Description

Position  Summary:   The  Prior  Authorization &  Eligibility  Specialist  ensures all patient accounts  are  valid with complete demographic  and insurance  information to successfully  process their  claims.    This role  has critical  day-to-day  reporting  and document control responsibilities relating  to insurance  companies, patients, and  3rd  party  billers.   

Duties & Responsibilities:   

  • Correspond with patients and insurance  companies to obtain necessary  information for   patient accounts  that have  invalid or missing  insurance  information or  are  rejected by   insurance  companies for  issues related to that information   

  • Document  eligibility  issues within EMR  for  insurance  follow-up specialist  to   pursue/resolve   Research  and maintain timely  filing  requirements  by  insurance  payor   

  • Audit requisitions on a  sample basis  for  proper medical coding.   

  • Prepare  and maintain reports for  monthly  adjudication from internal EMR, clearinghouse,   and insurances.    Review  3rd  party  biller  reports for  reasonableness and work with 3rd  party biller  to adjust  as needed.   

  • Streamline insurance  billing  related to send outs   

  • Identify  and report trends  in front-end rejections and other  metrics and work to minimize   issues and  optimize  processing  time and  collections   

  • Provide  outstanding  customer  service  to patients and develop and maintain  positive  working   relationships with  internal and external customers   

  • Establish processes aligned with objectives of organization and accommodate processes of   3rd  Party  Biller  for  optimal efficiency   

  • Protect patient, company  documentation, and ensure  overall  HIPAA  compliance.   


  • Full  Time, Non-Exempt  (hourly)   

  • Core  hours: Monday  –  Friday  8:00-5:00   

  • Onsite  position located in Waterford   What  we  offer:   

  • Competitive compensation commensurate with experience   

  • Qualifications:   Required:   

  • 5+  years professional  experience, with 3  years in medical billing  processes   

  • Experience  in medical billing  coding   

  • Professional certification  (CPC) or  planning/in process to obtain     

  • Experience  in handling  medical prior authorizations highly  desired   

  • Associate’s or  Bachelor’s degree  highly  desired  

Knowledge, Skills, and  Abilities:   

  • Strong  attention to detail  and organizational skills   

  • Effective  project management skills   

  • Ability  to  effectively  implement change  in  a  fast-paced  environment   

  • Proficient with  Microsoft  Office  applications   

  • Proficient with EMR(s)     Positive communication  skills at all  levels of the organization   

  • Excellent customer service  skills   

Who We Are:

Helix is a value-based, state-of-the-art clinical laboratory on a mission to elevate the lab space through compliance, high ethics, innovation and a best in class client experience. Helix incorporates the latest technology and methods to provide comprehensive diagnostics including toxicology testing, pathogen detection, blood testing and Pharmacogenomics (PGx) testing.

Expected Use and Disclosure of Protected Health Information:

Employees in this position are expected to have access to protected health information and other confidential business information from throughout the organization as is needed to fulfill their responsibilities in evaluating and reducing risk to the organization. No protected health information will be disclosed outside the organization unless specifically required by state or federal law. *This document is intended to describe the general nature and level of work performed and the requirements of the position. It is not intended to serve as an exhaustive list of all duties, skills and responsibilities of personnel so classified; nor is it intended to limit the right of any leader to assign or direct employees under his/her direction.