Apex Systems
Authorization & Cost Estimate Specialist
If interested in applying, please email a copy of your updated resume to Melissa at [email protected] (be sure to reference Job ID: 3013187)
Location:
Norwood, OH (candidates MUST be local to the Norwood/Cincinnati area or surrounding regions)
Duration:
6 month contract-to-permanent-hire opportunity
Schedule:
Monday-Friday, 8am-4:30pm
Pay
: $18-20/hour (depending upon experience); weekly pay on W2
Job Summary:
Responsible for collecting necessary insurance benefit and clinical information to authorize services. Determines the cost for the service by applying the patient benefits / coverage information and estimate functionality accessible through IT applications. This process is essential to ensuring the patient understands their financial responsibilities for the service rendered. This is a very dynamic environment as insurance plans, benefits, and coverage structures change frequently and the turnaround is essential so that treatment is not delayed. Utilizes online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, secure pre-authorizations, and determine patient liabilities within a timeframe before scheduled appointments and during or after care for unscheduled patients. Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the patient. Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed. Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements. Alerts physician offices to issues with verifying insurance and/or obtaining pre-authorizations. Demonstrates understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients' out-of-pocket liabilities. Connects patients with financial counselors when further explanation or education is needed or requested regarding payment plans or financial assistance; may conduct some basic financial counseling duties as necessary. Communicates with patients, physicians, clinicians, front-end staff, or translators to obtain missing patient demographic or insurance information. Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., workers' compensation). Maintains excellent relationships with physician's offices, insurance companies and other hospital departments Skills/Qualifications
Need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered. Additionally, this team serves as a point of contact within the organizations for questions and issues as they relate to insurance plans and coverage information. Must have clinical knowledge of services so appropriate information can be communicated/given to the insurance company which will ensure the service is rendered in the correct level of care. Reimbursement for the service rendered is dependent upon the insurance benefit verification process and meeting the authorization requirements of the insurance company Knowledge of the following preferred: EHR Programs (e.g., Epic), medical terminology, insurance plans and benefits. Proficient critical thinking, detail oriented, and problem-solving skills. Excellent communication (written and verbal) and interpersonal skills. Exceptional time management, conflict resolution, and multitasking skills. Works well in a team environment and able to work independently. Proficient in Microsoft Office products. Exhibits professionalism, trustworthiness, honesty, and integrity. Preferred Skills & Experience:
Customer service and/or call center experience. 1+ years of registration or insurance verification related experience.
Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.
Apex Benefits Overview:
Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.
If interested in applying, please email a copy of your updated resume to Melissa at [email protected] (be sure to reference Job ID: 3013187)
Location:
Norwood, OH (candidates MUST be local to the Norwood/Cincinnati area or surrounding regions)
Duration:
6 month contract-to-permanent-hire opportunity
Schedule:
Monday-Friday, 8am-4:30pm
Pay
: $18-20/hour (depending upon experience); weekly pay on W2
Job Summary:
Responsible for collecting necessary insurance benefit and clinical information to authorize services. Determines the cost for the service by applying the patient benefits / coverage information and estimate functionality accessible through IT applications. This process is essential to ensuring the patient understands their financial responsibilities for the service rendered. This is a very dynamic environment as insurance plans, benefits, and coverage structures change frequently and the turnaround is essential so that treatment is not delayed. Utilizes online systems, phone communication, and other resources to verify eligibility and benefits, determine extent of coverage, secure pre-authorizations, and determine patient liabilities within a timeframe before scheduled appointments and during or after care for unscheduled patients. Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the patient. Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed. Obtains pre-certifications and pre-authorizations from third-party payers in accordance with payer requirements. Alerts physician offices to issues with verifying insurance and/or obtaining pre-authorizations. Demonstrates understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients' out-of-pocket liabilities. Connects patients with financial counselors when further explanation or education is needed or requested regarding payment plans or financial assistance; may conduct some basic financial counseling duties as necessary. Communicates with patients, physicians, clinicians, front-end staff, or translators to obtain missing patient demographic or insurance information. Communicates liabilities directly to patients and provides education on key insurance terms and rules; may often handle patients with more complicated insurance plans (e.g., workers' compensation). Maintains excellent relationships with physician's offices, insurance companies and other hospital departments Skills/Qualifications
Need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered. Additionally, this team serves as a point of contact within the organizations for questions and issues as they relate to insurance plans and coverage information. Must have clinical knowledge of services so appropriate information can be communicated/given to the insurance company which will ensure the service is rendered in the correct level of care. Reimbursement for the service rendered is dependent upon the insurance benefit verification process and meeting the authorization requirements of the insurance company Knowledge of the following preferred: EHR Programs (e.g., Epic), medical terminology, insurance plans and benefits. Proficient critical thinking, detail oriented, and problem-solving skills. Excellent communication (written and verbal) and interpersonal skills. Exceptional time management, conflict resolution, and multitasking skills. Works well in a team environment and able to work independently. Proficient in Microsoft Office products. Exhibits professionalism, trustworthiness, honesty, and integrity. Preferred Skills & Experience:
Customer service and/or call center experience. 1+ years of registration or insurance verification related experience.
Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.
Apex Benefits Overview:
Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.