RCMS Insurance Authorization Specialist I
Description
Qualifacts is a leading provider of behavioral health software and SaaS solutions for clinical productivity, compliance and state reporting, billing, and business intelligence. Its mission is to be an innovative and trusted technology and end-to-end solutions partner, enabling exceptional outcomes for its customers and those they serve. Qualifacts’ comprehensive portfolio, including the CareLogic®, Credible™, and InSync® platforms, spans and serves the entire behavioral health, rehabilitative, and human services market supporting non-profit Certified Community Behavioral Health Clinics (CCBHC) as well as for-profit large enterprise and small business providers. Qualifacts has a loyal customer base, with more than 2,500 customers representing 75,000 providers serving more than 6 million patients. Qualifacts was recognized in the 2022 and 2023 Best in KLAS: Software and Services report as having the top ranked Behavioral Health EHR solutions.
If you want to work inside an atmosphere where innovation has purpose, and your ambition works to support our customers and those they serve, please apply today!
Job Title: Insurance Authorization Specialist
Job Description:
We are seeking a detail-oriented and organized Insurance Authorization Specialist to join our team at Qualifacts. The Insurance Authorization Specialist will be responsible for obtaining pre-authorization from insurance providers for medical procedures, treatments, and services, ensuring timely approval and reimbursement for our clients.
Key Responsibilities:
1. Review patient medical records, treatment plans, and insurance coverage to determine the requirements for pre-authorization of medical services.
2. Contact insurance companies via phone, email, or online portals to initiate pre-authorization requests and provide all necessary documentation and information.
3. Follow up with insurance providers to track the status of pre-authorization requests, resolve any issues or discrepancies, and escalate complex cases as needed.
4. Communicate with healthcare providers, patients, and insurance companies to coordinate pre-authorization processes and ensure timely approvals.
5. Maintain accurate records of pre-authorization requests, approvals, denials, and appeals in accordance with HIPAA regulations and company policies.
6. Collaborate with the billing and revenue cycle management teams to ensure that pre-authorization requirements are met and that services rendered are eligible for reimbursement.
7. Stay updated on changes in insurance policies, regulations, and reimbursement procedures to effectively navigate the pre-authorization process and maximize reimbursement opportunities.
8. Provide support and assistance to healthcare providers, patients, and internal teams regarding pre-authorization inquiries, appeals, and denials.
9. Participate in training sessions, meetings, and quality improvement initiatives to enhance knowledge and skills related to insurance authorization processes.
10. Adhere to company policies, compliance standards, and ethical guidelines while performing duties and interacting with stakeholders.
Qualifications and Skills:
- Bachelor’s degree in healthcare administration, Business Administration, or related field preferred.
- 0-2 years of experience working in insurance authorization, medical billing, or revenue cycle management in a healthcare setting.
- Sound understanding of medical terminology, insurance terminology, and healthcare billing processes.
- Excellent communication skills, both verbal and written, with the ability to interact professionally with insurance companies, healthcare providers, and patients.
- Proficiency in using insurance verification software, electronic health record (EHR) systems, and Microsoft Office applications.
- Detail-oriented with strong organizational skills and the ability to prioritize tasks effectively in a fast-paced environment.
- Knowledge of HIPAA regulations, insurance billing regulations, and compliance requirements.
- Ability to work independently and as part of a team, with a focus on delivering high-quality service and achieving departmental goals.
This is an exciting opportunity for a motivated individual with a passion for healthcare administration and insurance authorization to join our team and contribute to the success of our RCMS business. If you meet the qualifications and are ready to take on this challenge, we encourage you to apply.