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SalaryVERIFICATION AND AUTHORIZAATION COORDINATOR
About US Eye: US Eye, is a physician-led, patient-centric network of eye care practices committed to providing exceptional patient service through premium technology and unrivaled provider expertise. We are one of the nation’s leading multi-specialty physician groups providing patients with care in ophthalmology, optometry, dermatology and facial surgery. With 50 clinics and 5 surgery centers, led by 95 providers and more than 1,000 team members system wide, we deliver world class care to patients throughout Florida, the Carolinas and Virginia.
Job Summary:
Verification and Authorization Coordinators primary duties include verifying insurance eligibility; determining deductible, copay, and prior balances to be collected; updating insurance when necessary. Verification and Authorization coordinators are also responsible for obtaining authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed. Verification and Authorization Coordinators may be required to provide coverage on secondary duties as Financial Counselor and for retina appointments.
Verification and Authorization Coordinators primary duties include verifying insurance eligibility; determining deductible, copay, and prior balances to be collected; updating insurance when necessary. Verification and Authorization coordinators are also responsible for obtaining authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed. Verification and Authorization Coordinators may be required to provide coverage on secondary duties as Financial Counselor and for retina appointments.
Primary Duties:
- Verification
- Eligibility verification
- Verify eligibility as active staying a minimum of three days ahead of scheduled service.
- Verify eligibility as active for add on appointments, staying ahead of schedule and verifying eligibility the same day for services scheduled and performed on the same day.
- Use Phreesia or RTS to identify and correct inactive or incorrectly registered policies and address.
- Utilize payer websites for further verification when needed.
- Contact patients to update / obtain correct information when needed.
- Validate that the correct plan was chosen per the insurance guide and provide feedback to supervisor for feedback to upstream areas.
- Confirm network participation and advise patient of our provider’s network participation when needed.
- Forward new plans to supervisor for payer file updates.
- Document verification activities in NextGen to support productivity and quality tracking.
- Ensure NextGen system is updated.
- Copay, deductible, and prior balance verification
- Notate copays, deductibles, and prior balances to be collected.
- Authorization & PCP Referrals
- Obtain authorizations, referrals, pre-determinations or any other payer pre-service approval as needed, staying a minimum of three days ahead of scheduled service, and ensuring that authorization, referral or pre-determination is obtained for add on appointments in advance or on the same day of service.
- Obtain vision plan authorizations, as needed.
- Obtain PCP referrals for HMO’s and provide feedback to supervisor on any particularly difficult or time-consuming PCP offices.
- Obtain prior authorization or pre-determination as needed for clinic and facility services.
- Obtain prior authorization for procedures as required by insurance plans.
- Work NextGen task list for procedures including but not limited to stents and cross-linking which require prior authorization approval or pre-determination.
- Review MDI Pending notifications for imaging orders and obtain prior authorization for those which need approval.
- Apply and use Dextenza (Dextenza360) portal for authorizations and support.
- Document authorization, referral, pre-determination activities in NextGen.
- Adherence to applicable laws, regulations, and contractual obligations.
- Follows the principles of the Company’s Compliance Program as well as the Code of Conduct.
Secondary duties
- Financial Counseling - Patient Estimation, Calculation & Pre-service Collections
- Patient estimation & pre-service collections
- Verify insurance eligibility and benefits for all appointments staying a minimum of three days ahead of scheduled service calculate out of pocket patient responsibility.
- Utilize Availity or other estimation tools to determine patient cost.
- Place outgoing calls to patients to address patient responsibility amounts due prior to appointment.
- Coordinates patient assistance applications for Division of Blind Services and other agencies.
- Document financial counseling activities in NextGen.
- Customer service (Internal & External)
- Answers calls via the Financial counselor phone queue and responds to emails from staff / providers
- In person counseling
- Assisting and guiding patients with application for financing.
- Retina schedules
- Verify insurance eligibility and benefits for retina services.
- Obtain authorization, referral or pre-determination for retina services.
- Contact the patient to provide estimated out of pocket for retina services.
- Assist with patient assistance applications for Retina patients.
- Document insurance eligibility verification, authorization, referral or pre-determination activities in NextGen appointment details and complete insurance verification templates. Document patient assistance activities in NextGen shared notes.
- Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.
Competencies:
- Demonstrated ability to follow oral and written instructions.
- Demonstrated knowledge of material, methods, instruments, and equipment.
- Demonstrated ability to read, write and perform mathematical calculations.
- Must be able to maintain high degree of confidentiality. Ability to multi-task, work in a fast-paced environment and manage time accordingly in order to meet deadlines and requirements of the organization.
Position Type and Hours of Work:
This is a full-time position. Days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M. with occasional overtime.
Travel:
Travel may be required.
Required Education and Experience:
- A high school graduate or equivalent
- Proficient in computer and typing
- Knowledge of Microsoft Office products (Word, Excel)
- Excellent customer service skills in phone, person or via email
- Ability to manage multiple, ongoing tasks while maintaining professional composure.
- Have an understanding of insurance and medical terminology.
Preferred Education and Experience:
Bachelor’s Degree
BENEFITS:
401(K) Company Match
Medical and Dental Insurance
Vision Benefits
Flexible Spending Accounts
Pet Insurance
Disability Insurance
Life Insurance
Continuing Education
Paid Time Off
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Medical and Dental Insurance
Vision Benefits
Flexible Spending Accounts
Pet Insurance
Disability Insurance
Life Insurance
Continuing Education
Paid Time Off
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
