Covenant Physician Partners is hiring an Insurance Verification/Authorization Specialist at Texas Eye Care Network located in Corpus Christi, TX.

Shift: Monday - Friday

About the Opportunity

Work closely with the Revenue Cycle Manager while performing all components in the Insurance Verification / Authorization process for existing and new patients as well as working closely with staff. Supports the vision and mission of Covenant through providing excellent customer service.

Essential duties and responsibilities:

• Utilizes current system to conduct insurance verification and authorization validation on scheduled patients to ensure eligibility and that benefits are in order for accurate claim submission and payment.
• Utilizes the SSI online eligibility verification system, and/or may have to contact the Payer directly via telephone, and/or access payer website.
• Requests pre-authorization for scheduled procedures, urgent procedures and imaging.
• Accurately notate the account with actions taken for pre-certification.
• Coordinates Peer-to-Peer reviews with Providers for denied requests.
• Follows up on pending authorization requests in a timely manner.
• Communicates with Patient Financial Advocate regarding patient’s financial responsibility, to ensure the Front Office is able to collect moneys such as copayments for the procedures. Answers only non-medical questions and gives routine non-medical instructions.
• Must have working experience with all payer types: commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross over into different payers.
• Establishes knowledge of major payers needed by consistently reviewing confirmation reports to identify payer rejection issues and executes the payer procedures needed to reduce the occurrence of future rejections.
• Acts as the connection between internal and external customers to assist in the account billing resolution process and to escalate issues which adversely impact claim submission and payment.
• Ability to perform independent research prior to seeking management assistance.
• Experience and ability to identify billing or payer edit opportunities.
• Follows department policies and procedures as required to meet payer and regulatory requirements including procedures related to release of information, record retention, privacy and confidentiality.
• Meets and/or exceeds the daily production goal as defined by the Manager.
• Assists management team in providing training, assistance and/or guidance to other staff members in issues of accounts resolution through billing, collection and/or denial processing techniques.
• Provides information to Manager in identifying possible areas of concern that impact account billing or collections, accurately and in a timely manner.
• This role excludes performing any clinical tasks related to patient, to include assessment or evaluation of patient’s medical condition or providing clinical advice or medical care or recommendations.

About the Candidate

• High school education or equivalent
• 1 years in Healthcare Customer Service, Insurance Verification and Billing Systems from a Technical and Functional view (preferred)
• Word, Excel and Outlook experience is required.
• Ability to learn new programs and systems is required.
• Ability to read and evaluate Healthcare Receivables Information (required).
• Ability to effectively and correctly communicate to the staff, management and payers.

About Covenant Physician Partners

At CPP, we offer the opportunity to be part of an organization that’s advancing healthcare and creating a new model for the future. Covenant Physician Partners delivers superior value to patients, physicians, associates, and communities through professional and innovative services.

We provide an outstanding benefits package to our full-time associates that includes:

• Generous paid time off in addition to national holidays, two floating holidays, and a birthday holiday
• Medical, Dental, and Vision insurance after 30 days of employment
• $250 of professional development funds provided every year
• Invest in your future with tuition reimbursement and a company match on your 401k
• Associate discounts at major retailers such as Amazon Prime and Costco