Benefits Verification and Authorization Specialist

This is a fully remote position, open to applicants in Texas.

📋 Description

• Verify patient insurance eligibility and benefits, both in-network and out-of-network, prior to scheduled appointments, procedures, and services using payer portals, clearinghouses, and phone communication.

• Obtain, track, and follow up on prior and retrospective authorizations for office visits, diagnostic tests, and procedures.

• Document benefit details, authorization numbers, effective dates, and payer requirements in the practice management system/EHR.

• Calculate patient financial responsibility, including copays, coinsurance, and deductibles, for front-office staff and patients.

• Identify authorization requirements by payer and CPT code, flagging services at risk of denial.

• Monitor pending authorizations and escalate any delays impacting patient care or scheduling.

• Collaborate with providers, clinical staff, schedulers, and billing teams to resolve coverage issues and minimize claim denials.

• Address authorization-related denials by gathering necessary documentation and initiating appeals or retro-authorizations when suitable.

• Stay updated on payer policy changes, medical necessity criteria, and authorization workflows.

• Ensure compliance with HIPAA and relevant privacy and security standards.

⛳️ Requirements

• High school diploma or equivalent.

• At least four (4) years of experience in insurance verification, prior authorization, retrospective authorizations, or medical billing within a physician practice or outpatient setting.

• Proficient understanding of commercial insurance, Medicare, and Medicaid plans, including HMO/PPO structures and authorization processes.

• Familiarity with CPT, ICD-10, and HCPCS coding as it pertains to eligibility and authorization.

• Experience utilizing payer portals (e.g., Availity) along with practice management/EHR systems.

• Exceptional attention to detail, organizational skills, and ability to follow through on tasks.

• Strong written and verbal communication abilities.

• Capability to work independently in a remote setting with dependable high-speed internet and a private, HIPAA-compliant workspace.

🏝️ Benefits

• 100% premium coverage for employee's Health, Dental, and Vision Insurance.

• 50% premium coverage for dependents.

• 401k platform.

• WFH Stipend.

• Remote work environment.

• Reliable high-speed internet and a private, HIPAA-compliant workspace required for remote work.