Patient Benefits Specialist / Prior Authorization Specialist

Patient Benefits Specialist / Prior Authorization Specialist

If you're detail-oriented and passionate about helping patients navigate their healthcare coverage, this is the job for you! We're looking for a Patient Benefits Specialist to join our growing team! In this role, you'll play a key part in ensuring a seamless patient experience by obtaining pre-authorizations and pre-certifications for upcoming procedures, special testing and referrals. You'll also connect with patients prior to services to discuss insurance coverage and financial responsibility, helping them understand their benefits and feel confident in their care!

This is a full-time (1.0 FTE) position, working on-site at our Wausau office.

Essential Job Functions and Responsibilities

Obtains pre-authorizations / pre-certifications as required by health insurers or managed care providers for upcoming procedures, radiology or diagnostic testing, laboratory or other special testing.

Works with reception and clinical staff to coordinate referrals to outside facilities or providers.

Verifies Medicare, Medicaid and health insurance eligibility prior to upcoming services and procedures.

Contacts patients prior to appointment or procedure to discuss insurance coverage and benefits and patient financial responsibility.

Informs Patient Account Representatives of new or different insurance plans for patients, in case claims need to be resubmitted to the correct payer.

Works with clinical staff to manage appointment frequency, insurance coverage and benefits for patients on infusion therapy.

Maintains up-to-date knowledge of clinical guidelines, precertification requirements, and medical policies for services and procedures by routinely reviewing payer newsletters, regulatory and payer websites, and professional periodicals.

Acts as administrator for the insurance websites and obtains and maintains logon access to all payers' websites.

Performs other duties as assigned.

Minimum Qualifications

Education

High school diploma or equivalent required.

Licensure / Certification

Advanced training / certification in medical billing, coding, and / or insurance preferred.

Experience

Minimum of one-year experience in a medical billing role is required, or equivalent education.

Competencies Required

Knowledge

Working knowledge of medical and insurance terminology.

Basic knowledge of medical and insurance terminology, CPT, HCPCS, and ICD-10 coding.

Skills

Possesses interpersonal, communication, and listening skills necessary to deal effectively and courteously with patients and all staff members.

Proficient computer skills working in an Electronic Medical Record (EMR) and Practice Management software, and Microsoft Word, Excel, and the Internet.

Demonstrates professionalism and respect in all forms of communication and correspondence.

Abilities

Ability to maintain strict confidentiality of fiscal and health information.

Ability to work in a fast paced, multi-tasking environment and cope with rapidly changing demands while working as a team member.

Ability to prepare and gather information accurately and efficiently.