Patient Access Team Lead
Maric Healthcare, LLC
Remote
At Maric Healthcare, LLC, our compassionate and effective support provides a foundation for those navigating the complexities of drug dependence. Our opioid treatment centers assist individuals in moving toward a revitalized life, free from the constraints of addiction. Maric Healthcare, LLC exists to protect and improve the lives of people addicted to narcotic drugs. In accomplishing this mission, we strive for never-ending improvement and commitment to our values.
We don’t just offer a job; we invest in you. Our benefits are designed to support your health, your future, and your time away from work, so you can thrive both personally and professionally.
- Comprehensive Medical, Dental, and Vision Insurance on first day of month following 30 days of employment
- Company provided Basic Life and Voluntary Life Insurance to protect what matters most
- Flexible Ancillary Options such as hospital indemnity and critical illness coverage
- A 401(k) with Employer Match to help you build your financial future
- Generous Paid Time Off (PTO) plus 40 hours of Sick Leave
- 12 Paid Holidays and 2 Floating Holidays to recharge and celebrate
Join us and build not just a career, but a future you can be proud of.
Job Summary:
The Patient Access Team Lead performs insurance eligibility verification, prior authorizations, coordination of benefits (COB), and billing episode setup for assigned states while providing operational support and guidance to the Patient Access team across all Opioid Treatment Program (OTP) clinic locations. Working alongside Authorization & Benefits Specialists, this role reviews eligibility-related rejections and denial reports to help ensure accounts are updated accurately and timely, monitors eligibility and authorization reports to identify and resolve errors and maintains working knowledge of payer requirements across all states in which the organization operates. The Lead serves as a primary resource for team questions, troubleshooting, and workflow guidance, while assisting management with process improvement, quality oversight, and issue resolution. This role collaborates with clinic operations and Revenue Cycle Management to support accurate billing, reduce eligibility and authorization errors, minimize revenue leakage, and promote continuity of patient care.
Essential Functions:
Eligibility & Benefits Verification
- Review the insurance eligibility spreadsheet and corresponding documentation uploaded to patient charts to ensure accuracy of coverage information
- Monitor eligibility spreadsheets for errors and timely completion
- Reviews claim rejections and denials related to eligibility to ensure the accounts are set up properly
- Set up and maintain patient billing episodes in the EMR based on verified insurance benefits
- Monitor weekly eligibility reports for existing patients across all clinic locations, identifying terminated, failed, or changed coverage and taking appropriate action
- Coordinate with the RCM team regarding claims denials related to eligibility
- Communicate insurance coverage discrepancies to clinic staff and provide guidance on resolution
Prior Authorization
- Determine prior authorization requirements based on payer and plan type
- Review missing and expiring authorization reports to assign to the team according to the assigned states.
- Obtain, track, and enter authorizations into the billing system in a timely manner to prevent lapses in coverage
- Manage the authorization tracking report to proactively identify upcoming expirations and secure renewals before authorization gaps occur
- Coordinate with the RCM team regarding claims denials related to lack of prior authorization
- Maintain documentation of all authorizations within patient charts
Coordination of Benefits (COB)
- Identify and resolve COB issues across the patient population
- Review denials pertaining to Coordination of benefits (COB) to ensure the accounts are updated timely
- Collaborate with clinic staff to obtain accurate primary and secondary insurance information directly from patients when system resources are insufficient
- Ensure correct payer sequencing is reflected in the billing system
Process & Compliance
- Adhere to all state and federal regulations related to OTP billing, including Medicaid, Medicare, and commercial payer guidelines across seven states
- Support continuous improvement of eligibility and authorization workflows
- Maintain confidentiality in accordance with HIPAA regulations
Qualifications
- Minimum of 4-5 years of experience in healthcare revenue cycle, insurance eligibility and benefits verification, prior authorizations, or a related field.
- Strong working knowledge of insurance eligibility, coordination of benefits (COB), payer authorization requirements, claims, and billing episode setup.
- Experience working with Medicaid, Medicare, Medicare Advantage, and commercial insurance plans across multiple states.
- Demonstrated ability to review eligibility-related rejections, denial reports, authorization reports, and error reports to identify discrepancies and ensure timely account updates.
- Proficiency in electronic health records or practice management systems, payer portals, Microsoft Excel, and reporting tools.
- Strong analytical, problem-solving, and organizational skills, with the ability to prioritize issues and meet deadlines.
- Excellent communication and interpersonal skills, with the ability to serve as a resource for team members, troubleshoot issues, and provide workflow guidance.
- Ability to assist management with quality oversight, process improvements, workflow consistency, and resolution of complex eligibility and authorization issues.
- High attention to detail and commitment to accurate documentation, payer compliance, and protection of confidential patient information.
- Experience in behavioral health, substance use disorder treatment, or an Opioid Treatment Program (OTP) setting preferred.
- Frequently sitting at desk or computer while typing, completing paperwork, or meeting patients.
- Occasional lifting/carrying, paperwork, files, office supplies, up to 50 lbs.
- Occasional push/pull exerting up to 5-10 lbs. force, opening doors, file drawers, pushing files in drawers
- Occasional kneeling/crouching and ability to reach lower file drawers, stretching to store or retrieving materials.
Mental:
Position requires constant mental alertness, attention to detail, and high degree of accuracy required. Must be able to follow oral and written instructions and follow-through on all assignments. Must be able to work independently and be able to use sound judgment in critical clinical decisions.
4-5 years healthcare revenue cycle experience; knowledge of insurance eligibility, COB, authorizations, billing; experience with Medicaid, Medicare, commercial plans; EHR/practice management systems, payer portals, Microsoft Excel; strong analytical and communication skills.
Key Responsibilities
- verifying insurance eligibility
- obtaining prior authorizations
- coordinating benefits
Skills & Tools
Microsoft Excel, EHR, practice management systems, payer portals
Job Details
- Category: Healthcare Services - Allied Health
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — United States
- Languages: English
Benefits
- 401k matching
- Generous paid time off
- Retirement plan
About Maric Healthcare
A healthcare organization providing compassionate support for individuals navigating drug dependence. — Industry: Healthcare