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Eligibility Verification & Authorization Specialist

InStride Health · Remote, Estados Unidos Da América · Remote

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About Us

InStride Health’s mission is to deliver specialty anxiety and OCD care that works for every kid, teen, young adult, and family who needs it. Through this mission, we are expanding access to insurance-based care, increasing engagement in treatment, and improving treatment outcomes. We are doing this by combining research-backed clinical care and innovative technology to eliminate the major problems with care today: difficulty finding providers, months of waiting to be seen, arduous onboarding processes, and inconsistent use of evidence-based therapies and outcomes tracking. Our vision is to become the nation’s most trusted provider of pediatric anxiety and OCD care.

Team InStride Health: Our Core Values

  • Give Heart: We lead with heart, treating patients and their families the way we want our loved ones to be treated. 
  • Work Smart: We find smarter ways to solve hard problems and fix the broken mental health system by leveraging technology, diversity of thought, and innovation.
  • Have Humility: We leave our egos at the door, empowering our team to collaborate, celebrate diversity, and adopt a growth mindset.
  • Embrace Community: We all belong. We are in this together, and we never worry alone. We believe in each other and recognize that every voice matters.

About the Role

The Eligibility Verification & Authorization Specialist is responsible for supporting our patients and families through health insurance (payor) verification and authorization processes. Core functions include eligibility verification, obtaining authorizations, negotiating single case agreements, and coordinating between the Intake and Billing teams. You will directly support the InStride Intake team as they help our patients enroll in our treatment program. 

Our program includes Psychiatry, Therapy and Coaching services.  This position requires collaboration, strong communication and customer service skills to establish and enhance positive relationships with colleagues, patients, and others. 

Responsibilities:

  • Verify insurance coverage for patients using electronic verification systems, insurance websites, and phone calls to insurance companies.
  • Submit and Manage authorization requests through payer portals or by phone calls
  • Determine patient eligibility for insurance benefits by reviewing insurance policies, coverage limitations, and exclusions.
  • Communicate with patients to obtain necessary insurance information and update patient records as needed.
  • Coordinate with billing staff to ensure accurate billing and reimbursement processes.
  • Resolve insurance eligibility and coverage issues by working directly with insurance companies, patients, and the admissions team. 
  • Stay up-to-date on changes to insurance policies, regulations, and procedures to ensure compliance with industry standards.
  • Provide support and guidance to patients regarding insurance coverage, benefits, and financial responsibilities.
  • Collaborate with other members of the billing, scheduling, and admissions teams to streamline insurance eligibility and billing processes.
  • Provide feedback to the operations and growth leadership on any barriers in the eligibility and authorization process. Offer suggestions for how to improve those processes and enable speed to care. 
  • Maintain confidentiality of patient information and adhere to HIPAA regulations at all times.

What You Need to Succeed in the Role

  • Minimum of 2 years experience in an eligibility and authorization related role
  • Previous experience in healthcare administration, medical billing, health insurance, or insurance verification preferred.
  • Deep understanding of the insurance landscape including relevant terms, policies/procedures, authorization logistics, and ability to navigate through the ‘red tape’
  • Strong proficiency in using Availity to determine eligibility and submit authorization requests
  • Proficiency in Google Suite applications and electronic health record (EHR) systems.
  • Familiarity with HIPAA regulations and patient confidentiality requirements.
  • Strong task/project management experience. Demonstrated ability to execute independently, with high accountability to get the job done
  • Excellent communication skills, both verbal and written.
  • Exceptional attention to detail and accuracy.
  • Ability to work independently and as part of a multi-faceted team in a fast-paced environment. 
  • Comfortable working in a fast paced environment
  • High school diploma or equivalent; associate or bachelor’s degree preferred.

The expected annual salary for this role is between $52,000-55,000. Actual starting salary will be determined on an individualized basis and will be based on several factors including but not limited to specific skill set, work experience, etc.

Why Join Our Team

  • Generous benefits package (401k with match, Flexible PTO, paid holidays, paid service days, 4 week paid sabbatical, 12 week paid parental leave, health benefits starting on your first day, and more)
  • Opportunity to join a mission-driven company that is changing the landscape of pediatric mental health treatment
  • Chance to make a far-reaching impact by helping children and families access desperately-needed, evidence-based care
  • Opportunity to work with talented and experienced team members who have devoted their lives to solving this problem
  • Fully virtual: work from the comfort of your home with periodic in-person retreats

Commitment to Diversity, Equity, Inclusion, & Belonging (DEIB)

We want to make our clinical services available for everyone, no matter where you come from, what you look like, or how you identify. To achieve this, we recognize we must continually make progress in building a more diverse, equitable, and inclusive team. Through these efforts, we support two primary objectives at InStride Health:

  1. Providing high quality patient care to families. We are in a privileged position to support families during a vulnerable time in their lives. We approach all families and each other with compassion and are most effective as a diverse team where all individuals feel valued, respected, and accepted.
  2. Building a mission-driven business that lasts. Specifically, we believe our commitment to a supportive culture improves innovation, decision-making, and efficiency.

We invite you to share any additional information about yourself or your experiences that may not be reflected in your CV. Inclusion of this information is completely voluntary.

AI in the Application & Hiring Process at InStride Health: 

Our Commitment to Human Connection: At InStride Health, we believe the hiring process is a two-way journey grounded in genuine human connection and mutual fit. We recognize that AI tools are a helpful part of how we work and learn today, and we use it thoughtfully to enhance, not replace, human decision making. We use technology, including AI tools, to support our recruiting team with administrative tasks and to help organize applications based on job-related qualifications, all hiring decisions are made by our recruiting and hiring teams. We do not use AI as a substitute for human judgment, and we do not use it to autonomously disqualify candidates from consideration.

Guidelines for Your Application: We recognize AI as one of many tools candidates may use during the job search. Above all, we care about understanding your unique background, strengths, and perspective, and we value responses that reflect your own voice. To maintain a fair and human-centered process, we distinguish between using AI to prepare and using it to perform. We encourage you to leverage AI for brainstorming, research, or polishing your resume; however, your application and interview responses should ultimately reflect your own authentic thoughts and judgment. We ask that you refrain from using real-time AI usage during interviews and submitting entirely AI-generated content. We are far more interested in a thoughtful, human conversation than a 'perfect' machine-generated answer.

Please note that these guidelines are not intended to limit the use of assistive technology; if you utilize speech-to-text, screen readers, or other AI-enabled tools for accessibility purposes, you are encouraged to do so. We are committed to providing reasonable accommodations to ensure an accessible interview experience. Please let your recruiter know if you require an accommodation or an alternative interview format.

Beware of fake job postings and offers. All official communications from InStride Health will come from email addresses ending in @instride.health. We will never ask for personal information such as Social Security numbers or bank details during the application process. If you receive a suspicious job offer or communication, please contact our recruitment team directly ([email protected]) to verify its authenticity.