Insurance Eligibility Specialist

Job Summary

Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriate system. Your knowledge of insurance carriers and specific plan details will make you a valuable resource to patients, providers, and coworkers! Knowledge of medical codes and medical terminology required.

Duties And Responsibilities

• Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system.
• Obtains verification/eligibility for specific service.
• Research, handle, and make determination regarding insurance verification escalation issues and/or discrepancies.
• Audit, track, and trend insurance data entry error, communicate and provide feedback and training as needed.
• Verifies physician orders are accurate.
• Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections.
• Communication is maintained with providers, clinical staff, and patient in relationship to authorization status.
• Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested.
• Helps to maintain a professional atmosphere for patients, family members and staff.
• Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes.
• Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.
• Liaison with other departments for process improvements.
• Handle other projects as assigned.
  
  

Requirements And Qualifications

• High school degree or equivalent.
• Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred.
• Medical terminology required.
• Ability to prioritize and perform multiple tasks with many interruptions.
• EMR experience required; MEDENT preferred.
  
  

Physical Demands

• Requires prolonged sitting and/or standing; primarily using phone and computer.
• Position requires manual and finger dexterity and hand-eye coordination.
• Involves standing, sitting, and walking.
• Team member will occasionally be asked to lift and carry items weighing up to 10 pounds; normal visual acuity and hearing are required.
  
  

Benefits

We offer a comprehensive benefits package that includes health (with employer contribution), dental, and vision insurance, employer paid base life, and other voluntary benefits*. Time off benefits include paid combined time off (CTO) and seven paid holidays, plus a floating holiday after one year of service. Retirement benefits include a 401(k) with company contribution and profit sharing after one year of service. Qualified team members become eligible to participate in medical benefits on the 1st of the month following date of hire, and retirement benefits after 90 days.

We also provide professional development opportunities, flexible work schedules, wellness incentives, healthy vending options, and relaxed dress code on Fridays. Our community-focused culture encourages participation in local events, fundraisers, and causes chosen by our team. We are committed to providing our employees with the resources they need to thrive both personally and professionally.

• Other voluntary benefits include Voluntary Short Term Disability, Long Term Disability, Critical Illness, Accident Insurance, Supplemental Life Insurance, and legal and identity protection and pet insurance.
  
  

Who We Are

Excelsior Orthopaedics is a multi-specialty orthopedic practice that has been providing comprehensive care since 2002. We have multiple locations throughout the Western New York region and a free-standing ambulatory surgery center, Buffalo Surgery Center. Excelsior Orthopaedics offers a suite of in-house services including general orthopaedic evaluation and treatment, podiatry, physical & occupational therapy, nutrition counseling, sports training, outreach athletic training, orthopaedic express care, imaging, durable medical equipment, and an outpatient total joint program. Buffalo Surgery Center provides surgical and procedural treatments for orthopaedic, pain and spine, podiatry, total joint replacement, and gastrointestinal patients. Our mission is to transform the lives of our patients by restoring function and enhancing quality of life. We are committed to innovative care that is driven by patient needs and supported by the most skilled, experienced team in Western New York.

The pay range for this position is determined based on several factors, including the candidate’s years of experience, qualifications, training, licenses, designations, and the overall market conditions.

This job description does not state or imply that the duties and responsibilities listed are the only ones required of this position. Team members in this role will be required to perform other job-related duties at the discretion of the employer and may have additional duties assigned as necessary.

Excelsior Orthopaedics and Buffalo Surgery Center are committed to the full inclusion of all applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information.