Benefit Specialist - A3i : Job Details

Job DescriptionJob Description

Position Overview

The Benefit Specialist is responsible for obtaining benefit coverage information, pre-certification, and pre-authorization for cases referred to A3i and ensuring maximum reimbursement is received in the assigned cases.

Essential Duties and Responsibilities

 Reviews referral paperwork and related information that has been entered into the company database system to ensure accuracy.

 Experience with Cardiac Diagnostic Testing and Interventional Cardiology procedure prior authorizations strongly preferred

 Reviews diagnosis codes against coverage guidelines as needed, and notifies physician(s) to review coverage policy to determine whether or not they should continue with the procedure.

 Creates and maintains timely and accurate notes in the database system detailing all precertification activity related to each case.

 Contacts Payer(s) to determine available benefits for requested equipment and/or service; Follows guidelines set by Payer(s) to obtain authorization to supply equipment and/or service.

 Ensures adequate phone coverage by logging in and out of the phone queue in a timely manner.  Handles individual case load in accordance with guidelines (i.e. turnaround time) established by the client.

 Provides CPT and HCPCS coding support to physicians, as required.

 Negotiates with Payers and coordinates with the internal and external reimbursement staff to ensure payment and maximum profitability on each case.

 Maintains timely and regular communications with physician's office regarding the status of pending referrals.

 Notifies the appropriate team members in a timely manner regarding status of authorizations, so that service/equipment can be provided as needed.

Secondary Job Functions

• Supports the vision and values of A3i and abides by all A3i policies and procedures.
• Understands the product/service line provided by A3i.
• Improves and implements procedures as needed and/or assigned.
• Consistently provides optimum Customer Service to all internal and external customers.
• Consistently works to develop and maintain positive and professional relationships with all internal and external customers.
• Performs other duties and projects as assigned.

Skills/Abilities

· Ability to read and interpret claim notes, remits, denials, and/or explanation of benefits.

· Ability to escalate issues for resolution cross departmentally.

· Ability to accurately calculate refunds.

· Ability to prioritize work load to ensure position metrics are maintained.

· High attention to detail.

· Ability to interact effectively with all level of management and staff is required.

· Ability to communicate effectively, both written and orally.

· Ability to handle multiple projects in a customer service oriented environment.

· Ability to operate within Microsoft Office Suite applications to include MS Outlook, MS Word, MS Excel, PowerPoint and MS Access at an intermediate level.

· Knowledge of the accounting posting process.

· Ability to leverage excellent customer service skills to address any inquiries.

· Knowledge of, or the ability to learn, the product/service line provided by A3i.

Education Requirements

· Associate's degree or equivalent combination of education and experience is required.

Experience Requirements

· A minimum of 3-5 years of experience in Revenue Cycle management, collections, or related field is required.

· Experience in the field of Accounting is preferred.

Physical Requirements/Work Environment

The physical requirements and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit, stand; walk and talk or hear. Some bending, stretching, and stooping are required. Requires sitting for extended periods of time. Manual and visual dexterity sufficient to use a keyboard, monitor and calculator is required. Verbal communication and use of telephone is required. Employee may occasionally be required to lift, push and/or pull up to 20 pounds in weight.

NOTE: This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Employees may perform other related duties as assigned to meet the ongoing needs of the organization.

Company DescriptionWe Serve Patients! A3i is a patient-centered healthcare services company based in Central Florida, and is passionate about serving patients. We provide patient education, clinical study, and reimbursement support to physicians, hospitals, and device manufacturers.Company DescriptionWe Serve Patients! A3i is a patient-centered healthcare services company based in Central Florida, and is passionate about serving patients. We provide patient education, clinical study, and reimbursement support to physicians, hospitals, and device manufacturers.