Apex Systems · 1 week ago
Authorization & Cost Estimate Specialist
Norwood, OH
Contract
Onsite
Entry Level
$18/hr - $20/hr
1+ years expApex Systems is a world-class IT services company that serves thousands of clients across the globe. They are seeking an Authorization & Cost Estimate Specialist responsible for collecting insurance benefit and clinical information to authorize services and determine patient costs. The role requires effective communication and coordination with various stakeholders to ensure patients understand their financial responsibilities for services rendered.
Human ResourcesInformation TechnologyRecruiting
Responsibilities
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
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
Qualification
Required
Need expert knowledge of insurance plans, insurance regulations, and insurance benefit and coverages as they relate to the service rendered
Must have clinical knowledge of services so appropriate information can be communicated/given to 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
Customer service and/or call center experience
1+ years of registration or insurance verification related experience
Benefits
Medical
Dental
Vision
Life
Disability
Other insurance plans
ESPP (employee stock purchase program)
401K program
HSA (Health Savings Account on the HDHP plan)
SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions
Corporate discount savings program
On-demand training program
Access to certification prep
Library of technical and leadership courses/books/seminars
Certification discounts and other perks to associations that include CompTIA and IIBA
Company
Apex Systems
Apex Systems, a division of On Assignment, provides organizations with IT staffing solutions to address gaps in their current workforce.
1001-5000 employees
H1B Sponsorship
Apex Systems has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (28)
2024 (21)
2023 (35)
2022 (26)
2021 (29)
2020 (38)
Funding
Current Stage
Late StageLeadership Team
Roger Wahman
Chief Technology Officer - SVP
Andrea Schiola
Global Head of Technology Partnerships, SVP, Principal
Recent News
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