计费与授权专员
Billing & Authorization Specialist
职位名称：计费与授权经理
地点：南非
工作类型：全职，远程
工作时间：美国时间（上午9点-下午5点 EST）
薪资：南非兰特（ZAR）
我们正在寻找一位注重细节且有条理的计费与授权专员加入我们的团队。成功候选人将负责确保计费代码、保险授权和支持文件准确、合规、及时，并正确录入到相关的EMR和计费系统中。
该职位需要具备医学计费、保险授权流程、CPT代码和付款人要求方面的专业知识。在儿科医疗、儿科治疗、早期干预、行为健康或类似医疗环境中的经验将是非常大的优势。
计费与授权专员将与治疗师、临床医生、供应商和保险公司密切合作，确保服务得到适当的授权和计费，并高效解决任何差异。
主要职责
- 审核计费代码和保险授权，以确保准确性、完整性和合规性。
- 在服务计费前确保所有必要的授权已获得。
- 监控授权，确保其保持最新，并主动管理即将到期或需要延长的授权。
- 在EMR和计费系统中准确录入和维护授权和计费信息。
- 确保仅在有效且适当的保险授权存在时才进行服务计费。
- 当需要的文件、治疗信息或授权缺失时，主动跟进治疗师、临床医生和供应商。
- 直接与保险公司沟通授权状态、延期、拒付、付款人要求和计费相关问题。
- 及时调查并解决计费差异和授权问题。
- 保持授权、计费信息和相关沟通的准确且有序记录。
- 确保所有流程符合相关付款人要求和公司程序。
- 在常用于早期干预或儿科医疗的EMR和/或计费软件平台上工作。
- 在授权或计费问题影响服务提供或报销之前识别潜在问题。
- 与内部团队协作，确保顺畅的沟通
查看英文原文
Job Title: Billing & Authorization Manager
Location: South Africa
Job Type: Full-Time, Remote
Working Hours: US Hours (9am-5pm EST)
Salary: South African Rand (ZAR)
We are seeking a highly detail-oriented and organised Billing & Authorizations Specialist to join our team. The successful candidate will be responsible for ensuring that billing codes, insurance authorizations, and supporting documentation are accurate, compliant, up to date, and correctly entered into the relevant EMR and billing systems.
This role requires strong knowledge of medical billing, insurance authorization processes, CPT codes, and payer requirements. Experience within pediatric healthcare, pediatric therapy, Early Intervention, behavioral health, or a similar healthcare environment would be highly advantageous.
The Billing & Authorizations Specialist will work closely with therapists, clinicians, providers, and insurance companies to ensure that services are appropriately authorised and billed and that any discrepancies are resolved efficiently.
Key Responsibilities
- Review billing codes and insurance authorizations to ensure accuracy, completeness, and compliance.
- Ensure all required authorizations are obtained before services are billed.
- Monitor authorizations to ensure they remain current and proactively manage upcoming expirations or required extensions.
- Accurately enter and maintain authorization and billing information within the EMR and billing system.
- Verify that services are billed only when valid and appropriate insurance authorizations are in place.
- Follow up proactively with therapists, clinicians, and providers when required documentation, treatment information, or authorizations are missing.
- Communicate directly with insurance companies regarding authorization status, extensions, denials, payer requirements, and billing-related inquiries.
- Investigate and resolve billing discrepancies and authorization issues in a timely manner.
- Maintain accurate and well-organised records of authorizations, billing information, and related communications.
- Ensure all processes are completed in accordance with relevant payer requirements and company procedures.
- Work within an EMR and/or billing software platform commonly used by Early Intervention or pediatric healthcare providers.
- Identify potential authorization or billing issues before they impact service delivery or reimbursement.
- Collaborate with internal teams to ensure smooth communication and efficient resolution of outstanding matters.
Requirements
- Previous experience in medical billing and insurance authorizations.
- Strong understanding of CPT codes, medical billing processes, and payer requirements.
- Experience managing insurance authorizations, including obtaining, updating, extending, and resolving denied or missing authorizations.
- Excellent attention to detail and accuracy.
- Strong organisational and administrative skills.
- Ability to manage multiple authorizations, deadlines, and follow-ups simultaneously.
- Comfortable communicating professionally with therapists, clinicians, healthcare providers, and insurance companies.
- Strong problem-solving skills and the ability to investigate and resolve discrepancies independently.
- Experience working with EMR and/or medical billing software.
Originally posted on Himalayas