* Organized & Knowledgeable about Insurance Processes *
* Committed to Exceptional Customer Service *
* Sound Like You ? *
We are seeking a detail-oriented and compassionate Insurance Authorization Specialist to support our Outpatient Rehabilitation Services team. This position plays a vital role in ensuring patients receive timely access to services by securing insurance coverage, obtaining necessary authorizations, and providing financial counseling to patients and responsible parties.
Position Summary
This position is responsible for verifying insurance eligibility, obtaining prior authorizations, communicating financial responsibilities to patients and families, and collaborating with clinical and billing teams to ensure compliance with payer requirements. This role supports the organization's mission and core values through professional, accurate, and compassionate service.
Key Responsibilities
Insurance Verification & Authorization
- Verify patient insurance coverage, including plan types, effective dates, deductibles, co-insurance, and out-of-pocket maximums.
- Determine services requiring pre-determination or prior authorization and submit requests to insurance providers.
- Monitor authorization requests and follow up on approvals, denials, and additional documentation requirements.
- Request and track South Dakota Medicaid managed care referral cards.
Financial Counseling & Patient Communication
- Communicate insurance benefits, coverage limitations, and estimated patient financial responsibility.
- Ensure patients and responsible parties understand and sign required financial responsibility forms.
- Provide exceptional customer service while addressing questions and concerns related to insurance coverage and costs.
Documentation & Compliance
- Update electronic medical records and payer systems with eligibility information, authorization numbers, and insurance changes.
- Work collaboratively with therapists to ensure documentation meets payer requirements.
- Resolve insurance discrepancies and escalate issues as needed to prevent claim denials.
- Complete visit tracking for patient appointments when required.
Team Collaboration
- Communicate payer guideline changes, reimbursement updates, and payer-specific issues to billing staff.
- Partner with the Contracting and Credentialing Manager to ensure therapists maintain appropriate credentialing status.
- Provide coverage and support for credentialing-related activities as needed.
- Contribute positively within a collaborative, team-oriented environment.
If you are an organized professional with healthcare insurance authorization experience and a passion for helping others navigate the healthcare system, we encourage you to apply.
We would love to hear from You!