Verification of Benefits & Authorization Specialist

15 hours, 10 minutes ago
Full-time
Mid Level
Operations
Happy Health

Happy Health

Happy Health is a technology company located in Austin, Texas, focused on a consumer-first healthcare platform that specializes in at-home sleep diagnostics and personalized treatment. The company employs between 201 and 500 people and aims to empower patients through its innovative digital health solutions. Its flagship program, Happy Sleep, launched in 2024, provides results in as little as five days using FDA-cleared devices and AI-driven insights. The Happy Sleep platform offers comprehensive sleep health services, including home sleep tests, virtual consultations with board-certified sleep doctors, and personalized care plans. The Happy Ring, an FDA-cleared smart ring, serves as a clinical-grade device for accurate sleep testing and health monitoring. Happy Health also provides various treatment options tailored to individual lifestyles and budgets, with real-time data to adjust care plans dynamically. The platform extends its services to chronic condition management, integrating AI for notifications and clinical support.

information technology & services
201-500
Founded 2019
$60M raised

Description

  • Verify patient eligibility and benefits through payer portals, clearinghouses, and phone.
  • Obtain, track, and follow up on prior and retrospective authorizations for visits, testing, and procedures.
  • Document benefit details, authorization numbers, effective dates, and payer requirements in the EHR or practice management system.
  • Calculate and communicate patient copays, coinsurance, and deductibles.
  • Identify payer and CPT-code authorization requirements and flag denial risks before services are provided.
  • Monitor pending authorizations and escalate delays affecting care or scheduling.
  • Collaborate with providers, clinical staff, schedulers, and billing teams to resolve coverage issues and reduce denials.
  • Gather documentation and initiate appeals or retro-authorizations for authorization-related denials.
  • Stay current on payer policies, medical necessity criteria, and authorization workflows.
  • Maintain HIPAA and applicable privacy and security compliance.

Requirements

  • High school diploma or equivalent.
  • At least 4 years of experience in insurance verification, prior authorization, retrospective authorization, 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 for eligibility and authorization.
  • Experience using payer portals such as Availity and practice management or 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.
  • Bilingual English/Spanish skills preferred.

Interested in this position?

Apply directly on the company website

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