Verification and Authorization Specialist at Sourcefit

Position Summary:

We are seeking an experienced, motivated, and diligent benefit Verification and Authorization Specialist to join our dynamic team. The successful candidate will play a critical role in our healthcare delivery processes, ensuring compliance with Federal and State regulations and policies regarding benefit verification and authorization. The position requires outstanding communication skills, thorough knowledge of collection practices, and the ability to apply effective judgment in complex situations.

Job Details:

• Work from home
• Monday to Friday | 9 PM to 6 AM (Manila Time)
• *Following US Holidays

Responsibilities:

• Gain and maintain a thorough understanding of patient insurance eligibility and benefits across a wide range of payers, including but not limited to: Aetna, Cigna, BCBS, Humana, Worker’s Comp, Medicare, and Medicaid.
• Demonstrate specific knowledge of Authorization processes related to GAPs, Pre-determinations, PCP Referrals, and Single Case Agreements.
• Enter insurance and authorization information into EHR systems accurately and in detail, following Standard Operation Procedures.
• Follow up on pending or expired authorizations and referrals as assigned.
• Review authorization denials for accuracy and initiate the appeal process until the case is resolved, appeal options are exhausted, or the decision is made to discontinue the process.
• Document all call details per the Standard Operation Procedures of the department.
• Timely follow up and response to all Quality Reviews.
• Respect patients’ rights and responsibilities in the performance of job duties, maintaining patient privacy and confidentiality.
• Strict adherence to all HIPAA guidelines/regulations.
• Maintain a working understanding of NDC (National Drug Code) numbers, metric quantities, and infusion supplies.
• Continuously build a broad knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
• Share knowledge with other staff members and work effectively as a team member.
• Interact with others in a positive, respectful, and considerate manner.
• Perform other job-related duties as assigned.

Qualifications:

• A high school diploma or general education degree (GED) equivalent.
• A minimum of 3-5 years of healthcare industry experience, with at least 3 years in intake/verification roles.
• Home Infusion experience, or hospital or chemotherapy experience is required.
• Proven experience in calculating drug units.
• Intrathecal Pain Management experience is a plus.
• Strong math skills.
• Ability to recognize, evaluate, and apply good judgment in solving complex situations in accordance with laws and regulations.
• Excellent verbal and written communication skills with the ability to build relationships, negotiate, and work with a variety of internal and external stakeholders.
• High level of integrity and credibility, with a strong work ethic.
• Self-directed, detail-oriented, conscientious, organized, with the ability to follow through.
• Proficient in handling problems involving multiple variables in an organized manner within the position's scope.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.