HFI-Assure Fertility Partners of Houston is a member of The Prelude Network, a premium network of North American fertility clinics that leverage the latest science and technology to help patients achieve their family-building goals. Each member of The Prelude Network family is expected to demonstrate their commitment to safe, efficient, and compassionate patient care every day. And because every great patient experience starts with a great employee experience, we strive to provide our staff with everything they need to consistently deliver the highest level of personalized care.

POSITION SUMMARY:

The Authorization Specialist is responsible for providing a great patient experience by checking patient eligibility and initiating prior authorizations. Includes utilizing online resources, reviewing medical records, calling insurance companies, and completing authorization forms in Electronic Medical Record (EMF) system.

ESSENTIAL RESPONSIBILITIES:

• Check patient eligibility and insurance plan benefits via online payer portals and confirming with insurance companies
• Scan complete authorization form in EMR system
• Review medical records
• Initiate authorizations using online resources, insurance specific forms, and making outgoing calls to insurance companies
• Follow department procedures to ensure timely completion of benefit investigations
• Communicate with internal patient financial services department, clinical staff and external practice managers when inaccurate demographic information is supplied
• Review and update authorization information in the EMR system
• Support and actively participate in initiatives designed to improve individual and organizational performance.
• Coordinate with clinical staff to set up peer to peer meetings for physicians and insurance medical directors.
• Assist patients with insurance denials and appeals
• Performs other duties/special projects and tasks as assigned

KNOWLEDGE AND SKILLS:

• Able to read, interpret, and implement specified records.
• Knowlege of Medical and Diagnosis codes (CPT/DX)
• Demonstrated knowledge of medical terminology and office procedures.
• Demonstrated knowledge of third-party and insurance company operating procedures, regulations and billing requirements.
• Experience with Microsoft Office suite and Electronic Medical Record (EMR) system.
• Ability to effectively establish and maintain cooperative and effective working relationships
• Effectively prioritize competing responsibilities, with a sensitivity toward matters which are time sensitive.
• Exercise a high level of discretion and sensitivity to patient privacy.
• Ability to recognize, evaluate, solve problems and correct errors.
• Ability to use telephone, keyboard, computer, office equipment and software programs.

EDUCATION AND/OR EXPERIENCE:

• High School diploma or equivalent required
• 1-3 years’ work experience in a healthcare environment required

OTHER QUALIFICATIONS:

Must have working knowledge of healthcare regulatory and compliance policy (i.e., HIPAA).

Must be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner. Excellent communication skills, both written and verbal, particularly around complex issues. High integrity, including maintenance of confidential information. Must be able to exercise good judgment and positively influence others, including handling confrontations with poise and efficiency. Advanced computer skills (including, but not limited to spreadsheets, word documents, Internet and email). Experience with MS Word, Excel and ability to learning new computer programs. Shows initiative and enjoys working as a team in a fast-paced environment with strong attention to details.

• The Prelude Network is part of Inception Fertility, a family of patient-centered, tech-enabled brands that together seek to redefine the fertility patient experience. At Inception, we touch every stage of the fertility life cycle—from egg donations and preservation to fertilization, pharmaceuticals, and even financing—making us well positioned to help patients build families regardless of what their unique journey looks like. Our diverse portfolio also enables us to offer exceptional opportunities for professional growth across several fertility-related specialties.

Inception offers fantastic benefits to our team (Family members):

• FREE employee only coverage option for the medical, dental and vision plans plus FREE basic life insurance, EAP and long-term disability insurance!
• Adoption assistance and fertility benefits
• Maternity and paternity/partner paid leave
• 401k with generous match
• 10 Company-paid holidays
• PTO starting at 18 days/year
• Family member recognition program
• Continuing education/professional development reimbursement and time off
• Family member referral program