BizForce
We are seeking an experienced Eligibility & Prior Authorization Specialist to join our healthcare revenue cycle team. This role is responsible for accurately verifying patient insurance eligibility and benefits, determining coverage and authorization requirements, calculating patient financial responsibility, and securing prior authorizations for medical services. The ideal candidate has hands-on experience with eClinicalWorks (eCW) , insurance eligibility and benefits verification, and prior authorization processes. Strong knowledge of payer policies and healthcare insurance terminology is essential. Arizona insurance/payer experience is highly preferred. Key Responsibilities Perform accurate insurance eligibility and benefits verification to confirm active coverage and patient benefits. Verify deductibles, copays, coinsurance, benefit limitations, exclusions, and coverage requirements. Review payer policies and determine coverage requirements based on CPT codes and medical necessity guidelines. Utilize insurance payer portals and telephone systems to obtain and validate benefit information. Review payer fee schedules and benefits to calculate accurate patient responsibility estimates for pre-collection. Submit prior authorization requests through payer portals, fax, phone, or other required channels. Ensure authorization requests are complete and supported by all required clinical documentation. Monitor and follow up on pending authorizations and communicate authorization decisions promptly. Document authorization reference numbers, payer communications, requirements, and status updates accurately. Identify eligibility, coverage, and authorization discrepancies and coordinate with clinic staff to resolve issues. Maintain accurate insurance verification, benefit information, authorization activity, and patient estimates in eClinicalWorks (eCW). Communicate directly with patients regarding insurance benefits, coverage requirements, and estimated financial responsibility. Work professionally with patients, clinic teams, insurance representatives, and other healthcare stakeholders. Maintain a high level of accuracy when interpreting payer guidelines and entering insurance information. Protect patient information and maintain compliance with HIPAA, payer requirements, and applicable healthcare regulations. Perform other duties and responsibilities as assigned. Qualifications Healthcare insurance eligibility and benefits verification experience for at least 3 years. Recent hands-on eClinicalWorks (eCW) experience — required; minimum 6 months. Prior experience verifying insurance through payer portals and/or telephone systems. Experience interpreting insurance benefits and coverage requirements using CPT codes and payer policies. Hands-on experience submitting and following up on prior authorization requests. Strong understanding of insurance terminology, including deductibles, copays, coinsurance, exclusions, limitations, and patient responsibility. Experience preparing patient financial estimates for healthcare services. Excellent written and verbal communication skills. Strong attention to detail, organization, and follow-through. Ability to manage multiple insurance verification and authorization requests in a fast-paced, high-volume healthcare environment. Perks Permanent Work From Home Leave Credits Monetary Allowance Annual Bonus Weekly Paychecks Fixed Weekends Off Thriving Company Culture with Complete Autonomy Exclusive Specialized Training Programs Unlock Your Potential with a Highly Competitive Salary \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ Who are we? BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH! Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.
BizForce
