Authorization & Eligibility Coordinator

Company: Raintree Systems, Inc.
Location: Temecula
Posted on: January 15, 2022

Job Description:

Authorization & Eligibility Coordinator - Remote

Summary:

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 portals

Essential Responsibilities:

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 Clients.

Recognize and report on benefit and eligibility productivity and correctness.

Qualifications:

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

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Keywords: Raintree Systems, Inc., Corona , Authorization & Eligibility Coordinator, Other , Temecula, California