Medical Blling Authorization US

Company Description

Zen Medical Services focuses on optimizing revenue and reducing administrative challenges for healthcare providers by ensuring accuracy and compliance in medical billing processes. Our team is dedicated to verifying insurance policies, validating precise ICD/CPT/Modifier combinations, and maintaining a seamless cash flow for our clients. We emphasize proactive claim management by following up on unpaid claims within 30 days and keeping Account Receivables (A/R) beyond 90 days below 5%. Additionally, we perform daily monitoring of clearinghouse rejection logs and handle denial management to deliver efficient and reliable services.

Role Description

An authorization specialist for U.S. medical billing is responsible for obtaining prior authorization from insurance companies for medical services before they are provided. This role involves verifying patient insurance eligibility, managing referrals, submitting requests for approval, tracking authorization statuses, and ensuring all necessary documentation is collected for seamless billing

Key responsibilities

Obtain prior authorizations: The primary duty is to submit requests to insurance providers and get approval for services to ensure they are covered under the patient's plan.

Verify insurance eligibility: Confirming that a patient's insurance plan is active and benefits are valid before services are rendered.

Manage referrals: Facilitating the process of a patient being referred to a specialist for further treatment.

Data entry and tracking: Accurately entering and tracking data related to authorization requests, including follow-ups on expedited reviews and appeals.

Documentation management: Collecting and organizing all required patient and medical information to support the authorization request.

Communication: Clearly communicating with insurance companies, healthcare providers, and patients about the authorization process.

Compliance: Staying up-to-date with relevant regulations and ensuring all processes comply with laws and insurance policies.

Skills and qualifications

Understanding of medical billing: Knowledge of the medical billing cycle, including CPT codes, diagnosis codes, and claim submission.

Strong communication skills: Ability to clearly and effectively communicate with various parties.

Attention to detail: Meticulous attention to detail is crucial for handling complex rules and sensitive information.

Problem-solving: Ability to navigate and resolve issues that arise during the authorization process.

Technical and administrative skills: Proficiency with the specific software and systems used for medical billing and patient management