Jr Insurance Authorization Agent

at  Auxis

Job Summary:
The Jr Insurance Authorization Agent will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.
In your role, you will be supporting patient inquiries, directly affecting the patient experience and improving the health of communities.
Responsibilities:

Duties will be performed by each individual depending on the assignment of responsibilities:

• Perform pre-registration and insurance authorizations within 3-5 days prior to the date of service for both inpatient and outpatient services. For notification received with less than 3 days advanced notice perform within 24 hours of notification.
• Follow scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information in the approved standard format
• Assign Insurance Plans (IPlan’s) accurately
• Perform electronic insurance eligibility confirmation when applicable and document results
• Complete Medicare Secondary Payor Questionnaire as applicable for retention in the managing system (i.e. OnBase)
• Calculate patient cost share and be prepared to collect via phone or make payment arrangement
• Contact the patient via phone (with as much advance notice as possible, preferably 48 hours prior to the date of service)to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct the patient on where to present at the time of appointment
• Receive and record payments from patients for services scheduled.
• Utilize an appropriate communication system to facilitate communication with the hospital gatekeeper
• Ensure appropriate documentation is entered in standard format on the patient record. This should be performed in the applicable Health Information System (i.e. Meditech) and if necessary any other subsidiary systems if they are not automatically updated.
• Contact the physician to resolve issues regarding prior authorization or referral forms
• Research Patient Visit History to ensure compliance with payer-specific payment window rules
• Perform insurance verification and pre-certification follow-up for the prior day’s walk-in admissions/registrations and account status changes by an assigned facility as per SSC guidelines.
• Communicates with hospital-based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues
• Meets/exceeds performance expectations and completes work within the required time frames
• Implements and follows system downtime procedures when necessary
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned.

Skills and Experience:

• English – Spanish Language (Oral and writing 85% or higher), (B2+ or above).
• Must have a high school diploma.
• At least 6 months of experience in Customer Service positions.
• This job adjusts to the Eastern Time Zone and follows a US holiday schedule.
• Strong customer service skills
• Excellent communication skills
• Comfortable working in a high volume/high demand environment
• Good presentation and a polite, tactful and friendly character.

About Auxis:
Auxis places a high priority on employee growth and development, fostering an environment where you can advance in your career. Our culture empowers you to perform at your best, aligning with our team’s shared goals. We are continuously working to enhance our culture and environment, investing in tools to gain better insights into the heartbeat of our organization.

• Perform pre-registration and insurance authorizations within 3-5 days prior to the date of service for both inpatient and outpatient services. For notification received with less than 3 days advanced notice perform within 24 hours of notification.
• Follow scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information in the approved standard format
• Assign Insurance Plans (IPlan’s) accurately
• Perform electronic insurance eligibility confirmation when applicable and document results
• Complete Medicare Secondary Payor Questionnaire as applicable for retention in the managing system (i.e. OnBase)
• Calculate patient cost share and be prepared to collect via phone or make payment arrangement
• Contact the patient via phone (with as much advance notice as possible, preferably 48 hours prior to the date of service)to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct the patient on where to present at the time of appointment
• Receive and record payments from patients for services scheduled.
• Utilize an appropriate communication system to facilitate communication with the hospital gatekeeper
• Ensure appropriate documentation is entered in standard format on the patient record. This should be performed in the applicable Health Information System (i.e. Meditech) and if necessary any other subsidiary systems if they are not automatically updated.
• Contact the physician to resolve issues regarding prior authorization or referral forms
• Research Patient Visit History to ensure compliance with payer-specific payment window rules
• Perform insurance verification and pre-certification follow-up for the prior day’s walk-in admissions/registrations and account status changes by an assigned facility as per SSC guidelines.
• Communicates with hospital-based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues
• Meets/exceeds performance expectations and completes work within the required time frames
• Implements and follows system downtime procedures when necessary
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned