Authorization & Eligibility Coordinator
Company: Raintree Systems, Inc.
Posted on: January 15, 2022
Authorization & Eligibility Coordinator - Remote
Ensure 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
Responsible for the verification and financial calculations of
patient health insurance benefits via external insurance web
portals or over the phone.
Responsible for authorization submission as needed based on
patients health insurance requirements via external insurance web
portal or over the phone. Various Insurance payers via our
electronic clearinghouse or web portals
Assures all authorization information is documented completely and
accurately for claims processing.
Assures all insurance information has been completely and
accurately obtained. Documents all pertinent insurance information.
Documents information given or received to support actions taken on
insurance charges or referral issues.
Review, evaluate and assist in creating processes and workflows for
future benefit and enrollment teams.
Research and recommend any authorization, eligibility, contracting,
credentialing, enrollment or benefit eligibility issues to
Recognize and report on benefit and eligibility productivity and
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
required. Requires industry expertise.
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 Raintrees 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, as
well as how to teach end users in the solutions 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.
Education and/or Experience:
High School Diploma, GED, or equivalent work experience
Job Type: Full-time
Powered by JazzHR
Keywords: Raintree Systems, Inc., Corona , Authorization & Eligibility Coordinator, Other , Temecula, California
Didn't find what you're looking for? Search again!