Vitreous-Retina-Macula Consultants of New York PC is Hiring an Insurance Verification & Authorizations Representative Near New York, NY
Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matter
Insurance Verification determine if Participating in net work or out of Network- confirmed Members Benefits for services being rendered
Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies
Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emails
Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources
Coordinates with Providers and Members regarding authorization requests and/or activities
Communicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issues
Reviews all authorization requests for accuracy and prioritizing based on urgency
Documents communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for services
Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.
Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Performs other duties and special projects, as assigned
Qualifications:
Knowledge of CPT and ICD9/ICD10 coding/ Clinical.
Understanding of insurance plans, i.e. HMO, POS, PPO
Knowledge of Excel and Word
Excellent Organizational Skills; Attention to Detail
Exceptional Communication Skills
Working Knowledge of Insurance Company Operations and Procedures
Excellent customer service skills
Ability to prioritize work in a fast-paced environment
Computer skills
Appeals/Retro active request skills
Sending Specialty Prescription when needed
MRI Authorization Utilization Management
Knowledge of Manufacture Co-Pay Assistance Program/Foundation.