Summary

This position verifies coverage, benefits and obtains authorizations for surgeries, procedures and radiology services. Provides great customer service during interaction with patients, providers, Baylor staff, insurance companies and anyone else while performing all job duties.

The ideal candidate must be able to prioritize workload in order to meet productivity standards.

This position is located at our Greenway Plaza location with opportunities to work onsite and telecommute.

Job Duties

• Submits prior authorizations for services.
• Follows up on submitted authorizations, notates authorization in appropriate area in Epic for all services.
• Contact departments regarding missing clinical information if required by insurance company.
• Understands multi-specialty services authorizations and can pull appropriate clinical documentation for case submission.
• Updates referral statuses and collection efforts in Epic.
• Accurately documents all work efforts in patient's chart.
• Responds to and/or communicates status updates to MD office representatives and patients.
• Provides and explains educational material to patients.
• Assists with STAT verification requests in a timely matter.
• Responds to specific account inquiries by management.
• Answers Insurance Verification Helpline and resolves insurance inquiries from patients, physicians, and departments.
• Research claims denied for no authorization and perform retro authorizations.
• Investigates patient insurance coverage and demographic issues.
• Contacts Non-BCM PCP’s offices to obtain referrals.
• Obtains insurance referrals on behalf of Baylor PCP's.
• Creates estimates and collects patient out of pocket prior to services being rendered.
• Performs other job-related duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Three years of relevant experience.

Preferred Qualifications

• Prior authorization experience.
• Experience in a multi-specialty environment.
• Experience in a high volume and high paced environment.