Nystrom & Associates, Ltd.
Overview
Insurance Authorization Specialist
– full-time, remote (work from home) in Arden Hills. Nystrom & Associates, Ltd. is a team of mental health professionals offering psychiatric evaluations, clinical social work, and family therapy. The role verifies insurance eligibility and authorizations to ensure optimal reimbursements.
Job Duties The duties focus on verifying mental health or chemical dependency insurance eligibility, updating insurance information within 24 hours of receipt, obtaining initial authorizations/referrals as needed, and other duties as assigned by management. Other duties include the following:
Verification of Insurance Eligibility/Benefits for OP, ARMHS & CTSS services
Initiate necessary Authorizations/Referrals as needed
Completing the auth process as applicable
Appointments are flagged accordingly
Field/Resolve provider/clinic inquiries via Email or Task
Inquiries are followed up within 24 hours of creation
Attend biweekly staff meetings and any other meetings and/or training sessions as indicated
All other duties as assigned by Management
Expectations
Extreme attention to detail while multitasking
Extreme ability to organize and track large amounts of data
Verification Benchmarks are met on a time frame as established by Management
Flexibility
New Patient, Referral, Termed, CD Eval, CD Orientation, CDDA, CBDA & CBADA appointments are verified within 2 business days of being scheduled
Are marked with GREEN checkmark to confirm active coverage based on Insurance coverage, Provider exceptions, and Authorization requirements
Policies are set up correctly based on NAL approved Insurance Verification Process
Follow-up appointments are verified by the IVerify system
Any appointments found inactive are followed up on within 1 business day of the inactive verification and communicated to clinical staff
Manual reverifications of insurance not verified by the automated system are done as needed
Initial Authorization orders are entered into Allscripts EEHR according to authorization policy
Initial Authorizations are set up in Allscripts PM according to authorization policy
Patient Accounts are noted appropriately in EEHR and PM
Recognize/report trends and patterns with providers & clinics
Recognize/report trends and patterns with insurance companies
Back up Authorization Specialist with Authorization requests & approvals
Open communication with Supervisor & Lead
Arrive and leave on time according to assigned schedule
Adhere to attendance policies
Qualifications
Experience working with Excel preferred
Ability to work on dual monitors
Ability to work in multiple software programs
Minimum of two years working in health care facilities preferred, particularly with insurance verification and knowledge of prior authorization process
Familiarity with insurance company guidelines and HIPAA regulations
Hours Monday through Friday: General day time hours - Example: 7:00-3:30 or 7:30-4:00
Pay Information: 18-19$/hour depending on experience
Benefits
Medical & Dental insurance
Opportunities for professional growth and career advancement
Health Savings Account (HSA)
Flexible Spending Account (FSA) for applicable medical and dependent care expenses
Paid Time Off (PTO)
Paid Holidays
401(K) Retirement Plan with a generous employer matching program
Supplemental insurances, such as short term disability, cancer insurance, and accident insurance
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– full-time, remote (work from home) in Arden Hills. Nystrom & Associates, Ltd. is a team of mental health professionals offering psychiatric evaluations, clinical social work, and family therapy. The role verifies insurance eligibility and authorizations to ensure optimal reimbursements.
Job Duties The duties focus on verifying mental health or chemical dependency insurance eligibility, updating insurance information within 24 hours of receipt, obtaining initial authorizations/referrals as needed, and other duties as assigned by management. Other duties include the following:
Verification of Insurance Eligibility/Benefits for OP, ARMHS & CTSS services
Initiate necessary Authorizations/Referrals as needed
Completing the auth process as applicable
Appointments are flagged accordingly
Field/Resolve provider/clinic inquiries via Email or Task
Inquiries are followed up within 24 hours of creation
Attend biweekly staff meetings and any other meetings and/or training sessions as indicated
All other duties as assigned by Management
Expectations
Extreme attention to detail while multitasking
Extreme ability to organize and track large amounts of data
Verification Benchmarks are met on a time frame as established by Management
Flexibility
New Patient, Referral, Termed, CD Eval, CD Orientation, CDDA, CBDA & CBADA appointments are verified within 2 business days of being scheduled
Are marked with GREEN checkmark to confirm active coverage based on Insurance coverage, Provider exceptions, and Authorization requirements
Policies are set up correctly based on NAL approved Insurance Verification Process
Follow-up appointments are verified by the IVerify system
Any appointments found inactive are followed up on within 1 business day of the inactive verification and communicated to clinical staff
Manual reverifications of insurance not verified by the automated system are done as needed
Initial Authorization orders are entered into Allscripts EEHR according to authorization policy
Initial Authorizations are set up in Allscripts PM according to authorization policy
Patient Accounts are noted appropriately in EEHR and PM
Recognize/report trends and patterns with providers & clinics
Recognize/report trends and patterns with insurance companies
Back up Authorization Specialist with Authorization requests & approvals
Open communication with Supervisor & Lead
Arrive and leave on time according to assigned schedule
Adhere to attendance policies
Qualifications
Experience working with Excel preferred
Ability to work on dual monitors
Ability to work in multiple software programs
Minimum of two years working in health care facilities preferred, particularly with insurance verification and knowledge of prior authorization process
Familiarity with insurance company guidelines and HIPAA regulations
Hours Monday through Friday: General day time hours - Example: 7:00-3:30 or 7:30-4:00
Pay Information: 18-19$/hour depending on experience
Benefits
Medical & Dental insurance
Opportunities for professional growth and career advancement
Health Savings Account (HSA)
Flexible Spending Account (FSA) for applicable medical and dependent care expenses
Paid Time Off (PTO)
Paid Holidays
401(K) Retirement Plan with a generous employer matching program
Supplemental insurances, such as short term disability, cancer insurance, and accident insurance
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