Crossroads · 12 hours ago
Verification and Pre-Authorization Specialist - Greenville, SC
Greenville, SC
Full-time
Onsite
Entry, Mid Level
2+ years expCrossroads Treatment Centers is dedicated to treating patients with opioid use disorder, providing evidence-based medication-assisted treatment options. The Verification and Pre-Authorization Specialist will be responsible for verifying patients' benefits, processing eligibility requests, and ensuring compliance with state and federal regulations.
Health Care
Responsibilities
Verifying patients’ benefits during intake, daily/monthly batches, individual requests, and when notified on ineligibility or coordination of benefits issues
Research and processes eligibility requests according to business regulation, internal standards and processing guidelines
Verifies the need for prior authorizations or the need for retro billing
Coordinates with internal departments to work changes in payor billing guidelines, updating the patient identification, other health insurance, provider identification and other files as necessary
Responsible for processing enrollment and eligibility for our clients before releasing for submission to payers
Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices
Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits
Responsible to verify patients’ insurances’ benefits defined by departmental goals and insurance guidelines
Must understand and comply with the rules regarding Coordination of Benefits
Responsible for all eligibility related denials to identify trends to improve clean claim rates
Responsible for multiple daily reporting of productivity indicators through various reporting tools
Responsible to work all referrals within a 24/48-hour turnaround time from receipt
Other duties as assigned
Qualification
Required
Must have had at least 2 years electronic insurance verification, real time eligibility, and/or billing experience in a hospital and/or physician office setting
General Knowledge of HCPCS, CPT-4 and ICD9-10 coding and/or medical terminology
Familiar with multiple payer requirements and regulations for utilizing benefits
Must possess a good working knowledge of payer eligibility guidelines, payer portals, and clearinghouses to ensure a complete verification of benefits
Responsible for processing enrollment and eligibility for our clients before releasing for submission to payers
Understands and adheres to state and federal regulations and system policies regarding compliance, integrity and ethical billing practices
Responsible to verify patients' insurances' benefits defined by departmental goals and insurance guidelines
Must understand and comply with the rules regarding Coordination of Benefits
Responsible for all eligibility related denials to identify trends to improve clean claim rates
Responsible for multiple daily reporting of productivity indicators through various reporting tools
Responsible to work all referrals within a 24/48-hour turnaround time from receipt
Benefits
Medical, Dental, and Vision Insurance
PTO
Variety of 401K options including a match program with no vesture period
Annual Continuing Education Allowance (in related field)
Life Insurance
Short/Long Term Disability
Paid maternity/paternity leave
Mental Health Day
Calm subscription for all employees
Company
Crossroads
Since 2005, Crossroads has been at the forefront of treating patients with substance use disorder (SUD).
Founded in 2005Greenville, South Carolina, USA
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2015-01-08Private Equity
Leadership Team
Crossroads Treatment Centers
Founder & CEO
Recent News
Behavioral Health Business
2025-10-28
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2025-10-04
2025-09-12
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