Hybrid Verification and Pre-Authorization Specialist

Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery. This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery. We are committed to bringing critical services to communities across the U.S. to improve access to treatment for over 26,500 patients. Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and Virginia. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.

• 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.

• 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.

• 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.

• 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