Prior Authorization & Eligibility Specialist
Finance | Waterford Township, MI | Full Time
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
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.