Eligibility Specialist

Beale Personnel is recruiting an experienced Medical Insurance Eligibility and Preauthorization Specialist. This is an employer direct hire, permanent full time position on-site in Tucson, AZ.

Job description:

A comprehensive general Ophthalmology practice in Tucson, AZ is seeking an Eligibility and Insurance Authorization Specialist.

Job Summary:

The Insurance Authorization Specialist is responsible for obtaining prior authorizations for medical procedures, and ensuring that all services are authorized by insurance providers in a timely and efficient manner. This role plays a critical part in revenue cycle management and helps prevent claim denials due to authorization issues.

Key Responsibilities:

· Runs the Authorization Work list to determine which authorizations are pending, missing information or incomplete.

· Requirement is to be 2 weeks out in schedule and will handle 2 doctors.

· Documents in EMR under Authorization Tab the outcome of Drug/Procedure i.e.

· Units and any exceptions.

· Document in MDI i.e. Drug or procedure name – Payer Authorization Denials

· Verifies in the PX system that all authorization is complete and not pending for additional, documentation.

· If clinical staff calls regarding change of injection (it will not be done same day) it will be given on the next visit.

· Handles all incoming calls from Tech’s that pertain to authorization.

· Maintains accurate and detailed records of all authorization communications and approvals.

· Coordinate with clinical staff, patients, and insurance representatives to ensure authorization requirements are met.

· Monitor pending authorizations and follow up as needed to secure timely approvals.

· Communicate with patients and or staff regarding any authorization-related issues.

· Collaborate with billing and coding departments to resolve authorization or denial issues.

· Stay current on insurance provider requirements and authorization policies.

· Use EMR and practice management systems to track and document authorizations.

· End of day reconciles Fee Tickets

· Designated A&E Fax number

· Assist with Eligibility department as needed

Requirements:

• High school education
• One or more years Prior Insurance preauthorization experience
• Proficiency in EMR systems..