Benefits Verification and Authorization Specialist

Job not on LinkedIn

🔥 17 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $18 - $22 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Happy Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

🔧 Hardware

🤖 Artificial Intelligence

💰 $60M Series A - Happy Health on 2022-08

Healthcare • Hardware • Artificial Intelligence

Happy Health is a consumer-focused sleep medicine company that operates the Happy Sleep platform. It combines an FDA-cleared medical wearable (the Happy Ring) for at-home, clinical-grade sleep testing with virtual care delivered by board-certified sleep physicians and a coordinated care team. The company offers prescription-based home sleep testing, personalized treatment options (CPAP, custom devices, surgery, behavioral interventions), nightly monitoring and ongoing care, AI-enhanced health tracking, same-day virtual appointments, and works with major insurers across most U. S. states.

📋 Description

• Verify patient insurance eligibility and benefits, both in-network and out-of-network, before scheduled appointments, procedures, and services via payer portals, clearinghouses, and phone • Obtain, track, and follow up on prior and retrospective authorizations for office visits, diagnostic testing, and procedures • Document benefit details, authorization numbers, effective dates, and payer requirements in the practice management system/EHR • Calculate patient financial responsibility, including copays, coinsurance, and deductibles, for front-office staff and patients • Identify authorization requirements by payer and CPT code and flag services at risk of denial • Monitor pending authorizations and escalate delays affecting patient care or scheduling • Collaborate with providers, clinical staff, schedulers, and billing to resolve coverage issues and reduce claim denials • Respond to authorization-related denials by gathering documentation and initiating appeals or retro-authorizations when appropriate • Stay current on payer policy changes, medical necessity criteria, and authorization workflows • Maintain compliance with HIPAA and applicable privacy and security standards

🎯 Requirements

• High school diploma or equivalent • Minimum of four (4) years of experience in insurance verification, prior authorization, retrospective authorizations or medical billing in a physician practice or outpatient setting • Working knowledge of commercial insurance, Medicare, and Medicaid plans, including HMO/PPO structures and authorization processes • Familiarity with CPT, ICD-10, and HCPCS coding as it relates to eligibility and authorization • Experience using payer portals (e.g., Availity) and practice management / EHR systems • Strong attention to detail, organization, and follow-through • Excellent written and verbal communication skills • Ability to work independently in a remote environment with reliable high-speed internet and a private, HIPAA-compliant workspace

🏖️ Benefits

• 100% premium coverage for employee's Health, Dental, and Vision Insurance • 50% premium coverage for dependents • 401k platform • WFH Stipend • Remote work environment • Reliable high-speed internet and a private, HIPAA-compliant workspace required for remote work