Job Title: WI- Insurance Auth Rep

Location: West Allis, WI, 53066

Duration: 03 Months of Contract

Shift 1st: 8am-4:30pm w/ a 30 min lunch

NOTE: Must have Authorization experience

Must-Have:

• High School Diploma
• Must have 1 year of experience in providing customer service that includes experiences in patient accounts, third-party payer plans, laccounts receivable/collection processes, and medical clinic processes and workflow.
• Must have understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/ pre-certification/ authorization processes.

Primary Purpose:
Maintains, confirms and secures referrals, authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information. Maintains database of payer authorization requirements.

Major Responsibilities:

• Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/on-line eligibility systems.
• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counsellors, patients and third-party payers to complete the pre-certification process.
• Collaborates with internal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
• Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
• Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.
• May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
• Maintains files for referral and insurance information, and enters referrals into the system.
• Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre- authorization and a list of current accepted insurance plans.

Education Required: High School Graduate.

Knowledge, Skills & Abilities Required:

• Knowledge of third-party payers and pre-authorization requirements.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / pre-certification / authorization processes.
• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, physician practice management, and electronic medical records systems.
• Strong analytical, prioritization and organizational skills.
• Ability to work independently with minimal supervision and to manage multiple priorities. Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.

Physical Requirements and Working Conditions:

• Exposed to a normal medical office environment.
• Sits the majority of the workday.
• Operates all equipment necessary to perform the job.

Job Type: Contract

Pay: $22.00 - $25.00 per hour

Expected hours: 40 per week

Weekly day range:

• Monday to Friday

Experience:

• Medical billing: 1 year (Preferred)
• Insurance Authorization: 1 year (Required)

Ability to Commute:

• Milwaukee, WI 53227 (Required)

Ability to Relocate:

• Milwaukee, WI 53227: Relocate before starting work (Required)

Work Location: In person