RCMS Insurance Authorization Specialist III Vadodara, India - Qualifacts Systems Inc

Description

Description

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 Responsibilities for the Insurance Authorization Specialist III

Identify patient pre-authorization/referral requirements and ensure they are met and in place in a timely manner to facilitate efficient billing and payment for multiple specialties

Track and follow up on all pending authorizations depending upon payer guidelines

Process authorizations in a variety of methods and work with the payers to secure authorizations

Verify authorization quantities and effective dates are returned and processed correctly by the payers, and loaded correctly in all systems

Organize work to avoid lost revenue due to filing limitations

Identify opportunities to improve authorization efficiencies electronically via Availity, payer portals, etc.

Review Outpatient and Inpatient accounts to identify if notification, authorization and/or referrals are required and obtains prior to service being rendered and within payer guidelines

Review and submit authorization, referrals, and other medical necessities timely to ensure that patients can keep scheduled appointments, while following departmental procedures

Facilitate timely telephone calls and online inquiries regarding status of outstanding referrals and/or authorizations and notifications

Review, rectify, and clearindividual and batch Worklist errors and alerts to ensure account quality and accuracy

Identify accounts that have been postponed or cancelled and removes authorizations that are no longer valid and request updated authorizations

Troubleshoot insurance denials and billing discrepancies and prepare paperwork for appeal submission regarding prior authorizations

Qualifications of the Insurance Authorization Specialist III

1+ year in Patient Access/Patient Registration, Patient Accounts, or a physician's office in which the candidate directly managed verification of eligibility, obtaining referrals and authorizations, and/or registration of demographic and insurance information

Experience in both billing and collections

Knowledge, Skills, and Abilities of the Insurance Authorization Specialist III

Knowledge of and ability to explain concepts of medical benefit plan design

Excellent organizational, teamwork, and time management skills

Highly motivated and detail-oriented

Good troubleshooting skills