Team Lead – Prior Auths, Insurance Verification
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Job Description
Team Lead in Prior Auths & Insurance Verification at GetixHealth guiding specialists. Oversee insurance verifications and claim resolutions in a fast-paced environment.
Responsibilities:
- Review self-pay accounts to verify insurance coverage.
- Analyze and resolve unpaid claims.
- Contact insurance carriers for claim status and payments.
- Research claims using online tools.
- Gather and submit supporting documentation to insurance carriers.
- Submit appeals when necessary.
- Review and apply contractual terms.
- Communicate with patients/guarantors to expedite claims.
- Assist with special projects and additional duties as needed.
- Ensure compliance with information security policies.
- Monitor inventory and provide reporting on open claims.
- Report security risks as per procedures.
Requirements:
- 7+ years’ experience in a facility setting performing insurance follow-up/ denials management
- Knowledge of UB04/CMS 1450 and CMS 1500 claim forms, EDI, HCPCS, ICD-9/ ICD-10, CPT, DRG’s and ability to interpret an Explanation of Benefits
- Complete working knowledge of billing instructions and procedures for each payer source according to regulations and guidelines
- Knowledge of Commercial, Governmental and third-party denials and appeals processes
- Knowledge of billing systems
- Must have effective organizational skills and a high attention to detail
- Medical terminology required
- Must demonstrate the ability to adapt to change, maintain professionalism in challenging situations, and work in a Business professional environment
- Medi-Cal knowledge a major benefit
- High school diploma or college degree from an accredited college or university
Benefits:
- Comprehensive Health Coverage: Group medical, dental, and vision plans available from the first day of the month following 90 days of full-time employment.
- Life and Disability Insurance: Basic life/AD&D, short-term, and long-term disability coverage provided, with options for voluntary life/AD&D.
- 401(k) Retirement Savings Plan: Eligible to participate in the company’s 401(k) plan at the beginning of the first calendar quarter following 6 months of continuous service.
- Paid Time Off (PTO): Accrue Paid Time Off starting on your first day of employment.
- Flexibility in Benefits: The company reserves the right to amend, modify, or terminate any benefits programs as needed.
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