Insurance Authorization Specialist

Summary/Objective
Under limited supervision the Insurance Authorization Specialist reviews and manages the benefits and authorizations for hospitals and physicians. This type of specialist acts as an intermediary between the medical institution, patients, and the insurance agency. They assist in verifying benefits and obtaining authorizations for inpatient and outpatient services. 

Essential Job Functions

• Maintain work queue assigned by the client

• Verify benefits and secure auth or inpatient and outpatient services.

• Performs other duties as directed.

• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

Key Success Indicators/Attributes

• Ability to prioritize and multi-task in a fast-paced, changing environment.

• Demonstrate ability to work in all work types and specialties.

• Demonstrate ability to self-motivate, set goals, and meet deadlines.

• Demonstrate leadership, mentoring, and interpersonal skills.

• Demonstrate excellent presentation, verbal, and written communication skills.

• Ability to develop and maintain relationships with key business partners by building personal credibility and trust.

• Maintain courteous and professional working relationships with employees at all levels of the organization.

• Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position.

• Demonstrate excellent analytical, critical thinking and problem-solving skills. 

• Manage the Individual KRA’s as per the provided metrics.

• Understand client requirements and specifications of the project and ensure targeted collections are met on a daily / monthly basis.

• Meet the productivity targets of clients within the stipulated time. Ensure timely follow-up on pending claims and prepare and maintain individual status reports.

• Skill in operating a personal computer and utilizing a variety of software applications is essential.

• Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes is an added advantage.

• Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation is an added advantage.

Supervisory Responsibility

No

Work Environment

This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. This position occasionally requires long hours and weekend work.

Travel

Minimal travel required; up to 5%

Required Education and Experience

Knowledge of medical and insurance terminology such as CPT, ICD-9, ICD-10, HCPCS, co-pay, deductible or co-insurance, and full understanding of hospital/physician billing. Minimum 1-2 years’ experience in Medical Billing/Coding and experience with standard office software products. High School diploma or equivalent. 

Preferred Education and Experience

N/A

Additional Eligibility Qualifications

N/A

Security Access Requirements

In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega set forth in the “Omega Field Employee” profile. 

Equal Employment Opportunity:

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities, and activities may change at any time with or without notice.  Employee may perform o

Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com

We offer a comprehensive benefits package that may include health, dental, and vision coverage, voluntary insurance options, a 401(k) plan with employer match, professional development opportunities, paid time off, and holiday pay. Eligible employees may also have the opportunity to participate in bonus programs, commissions, or other variable incentive plans. Benefits and incentive eligibility may vary based on position, location, and tenure.

AAP/EEO Statement

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com.