Eligibility and Prior Authorization Specialist
About the Company
CardioOne partners with independent cardiologists to provide innovative solutions that improve patient outcomes and reduce costs. Our value-based cardiology care solutions help our physician partners thrive in the shift to value-based care. CardioOne offers a magnificent work environment, good working conditions, and competitive pay.
We take pride in creating a culture of employee engagement that translates into an exemplary patient experience. Join us in our mission to positively impact US cardiology.
About the Role
Our rapidly growing Cardiology practice is seeking a motivated individual to join as our Eligibility and Prior Authorizations Specialist. In this role, you will work directly with an interdisciplinary team of healthcare professionals to verify insurance eligibility and obtaining prior authorizations for medical procedures. You will report to the Practice Manager.
This position is full-time and requires being onsite at 43 Yawpo Avenue, Suite 6, Oakland, NJ 07436.
Schedule: Monday through Friday, no weekends, 7:30AM to 4:30 PM.
Compensation: $19 per hour, dependent on experience.
Benefits: Medical, Dental, Vision, Paid Time Off
What you'll do:
- Verify insurance eligibility for patients and analyze policy coverage to maintain accurate patient accounts in the EHR system.
- Determine deductibles, co-payments, and co-insurance for patients covered by participating insurance plans.
- Ensure active insurance coverage for patient appointments; update accounts with inactive insurance and communicate with patients for necessary information.
- Collect payments including co-pays, co-insurances, deductibles, and prior balances from patients.
- Assist with appointment scheduling and referrals between departments, acting as a liaison with participating insurance plans and patients.
- Review patient chart documentation to ensure compliance with medical policy guidelines.
- Obtain authorizations through EHR systems, payer websites, or phone calls, and diligently follow up on pending cases.
- Maintain updated payer files to meet authorization requirements and initiate appeals for denied authorizations.
- Address clinic inquiries regarding payer medical policy guidelines and verify accuracy of CPT and ICD-10 codes in procedure orders.
- Contact patients to discuss eligibility and authorization statuses
- Schedule procedure at outpatient facilities and obtain authorizations.
- Perform other assigned duties as assigned.
What you'll need:
- Strong understanding of insurance verification and procedure authorization processes impacting revenue cycles.
- Familiarity with payer medical policy guidelines for effective eligibility and authorization management.
- Familiarity with EHR system such as Athena, EPIC, ECW (Athena is a plus)
- Basic knowledge of human anatomy and medical terminology.
- Proficiency in using CPT and ICD-10 codes.
- Excellent computer skills including MS Excel, Word, and Internet navigation.
- Detail-oriented with exceptional organizational skills.
- Ability to prioritize tasks effectively to meet deadlines.
- Outstanding customer service skills with clear and effective communication abilities.
- Capacity to multitask and maintain focus in a high-volume, time-sensitive work environment.
Work Location:
You will work out of the Oakland, New Jersey office.
Additional Information
Full-time base hourly rate of $19 (commensurate with experience) per hour plus medical, dental, and vision benefits.
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