Hybrid Verification and Pre-Authorization Specialist - Greenville, SC

Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Crossroads is a leading addiction treatment provider of outpatient medication-assisted treatment (MAT). We treat patients with opioid use disorder (OUD) using medications such as methadone and suboxone/ buprenorphine. We pride ourselves in supporting our patients’ medical and personal recoveries from substance use disorder. Starting our fight against the opioid addiction crisis in 2005, Crossroads has remained physician led and patient focused as we’ve grown to 100+ clinics across nine states. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.

Day in the Life of a Verification and Pre-Authorization Specialist

• 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.

• Must complete and retrain base training.

• Other duties as assigned.

Education and Experience requirements

• 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.

Hours and Schedule

• Position will be fully in office during training period which may vary depending on candidate's ability to meet competency requirements. Once requirements have been met, the employee may transition to working three days in office per week and two days remote.

Benefits Package

• 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