Medical Insurance & Authorization Specialist

USA Clinics Group is looking for an organized and motivated individual to join the team as our newest Insurance Verification/ Prior Authorization Specialist! This position performs the function of obtaining referrals, and/or authorizations prior to the service date for test, procedures, and admissions into the clinics.

Remote work is not an option. Must be able to work in our Northbrook, IL office Monday-Friday.

• Reviews referring physician and patient documentation for Medical Necessity against insurance protocol requirements for pre-certification purposes
• Actively communicates with staff regarding status of authorization. Communicates the need for reschedule and/or cancellation if authorization not in-hand
• Directs liaison to offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements
• Responsible for scheduling STAT, emergent patients for outpatient diagnostic exams
• Interacts with patients, their representatives, physicians, physician office staff, and others to gather and ensure accuracy of demographic, billing and clinical information
• Produces and distributes required forms with accurate patient information
• Performs additional duties as assigned

Requirements

• High school graduate Required

• At least 2 years of prior experience in a healthcare setting handling benefit verification and prior authorizations Required
• Billing or coding certifications Preferred
• Strong computers skills and excellent typing skills
• Immaculate attention to detail and excellent proofreading skills
• Excellent Customer Service skills
• Strong data entry skills
• Excellent organizational skills

Benefits

• Health
• Vision
• Dental
• 401K
• PTO