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Authorization & Eligibility Coordinator Remote U.S. (designated states)
This position is fully remote and may be performed from one of the following U.S. states: AL, AZ, FL, GA, IN, KS, MA, MI, MS, NC, NV, OR, PA, SC, TN, TX.
The Authorization & Eligibility Coordinator ensures quality and timely benefit/eligibility verifications along with the management of client enrollment and credentialing for multi-specialty medical professional services with various insurance payers via our electronic clearinghouse or insurance web portals
Duties and Responsibilities:
- Responsible for the verification and eligibility of patient health insurance benefits via external insurance web portals or over the phone.
- Responsible for authorization submission as needed based on patient’s health insurance requirements via external insurance web portal or over the phone.
- Assures all insurance information has been completely and accurately obtained. Documents all pertinent insurance eligibility information.
- Documents information given or received to support actions taken on insurance issues.
- Assures all authorization information is documented completely and accurately for claims processing.
- Review, evaluate and assist in creating processes and workflows for future benefit and authorization teams.
- Monitor authorization exceptions to ensure timely claim billing.
- Communicate with clients regarding authorization or eligibility issues or trends.
- Assist external departmental personnel in strategically critical issues as the need arises
Position Proficiencies and Requirements
- High School Diploma, GED, or equivalent work experience
- Requires consistent judgment using software and industry expertise to analyze client needs and processes and then exercise discretion regarding how to configure and customize the solution, which not only includes Raintree’s product but also a variety of vendor partners (clearinghouses, payment processors, faxing solution providers, patient payment processors, Revenue Management services, etc) which are only brought into play as needed / appropriate
- Ability to teach end users in the solution’s optimal use, which is different for every client.
- Requires knowledge of multiple medical specialties and the rules regarding their billing and documentation (which vary by state and sometimes by county within a state)
- Understanding of accounting principles governing corporate reporting, teaching – including developing custom training plans and documentation, understanding of software engineering / development processes.
Competencies to Drive Success
- Well-developed verbal, listening and phone communication skills
- Good written communication skills with the ability to write routine correspondence
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
- Ability to define problems, collect data, establish facts, and identify trends.
- Ability to exercise good judgment and escalate issues appropriately
- Strong organizational skills and ability to execute manual detailed tasks.
- Strong customer service focus and commitment.
- Ability to establish and maintain effective working relationships within the team.
- Ability to work well with diverse personalities.
- Tactful, mature and flexible.
- Ability to work remotely. Strong video conferencing etiquette.
Our Perks
Remote Work/Work From Home
Paid Time Off/11 Paid Holidays/Year-End Holiday Break
Health, Dental, Vision, HSA/FSA
401K with Company Match
Disability & Life Insurance
Employee Assistance Program
Paid Parental Leave.
