Prior Authorization Specialist

Position Description & Requirements

PRACTICE OVERVIEW

Bloom Family Eye Center through its owned and affiliated practices is a leading provider of comprehensive medical and surgical eye clinic in Ohio. As a physician-led and physician-owned, we offer complete medical eye examinations by specialists in the field of ophthalmology, including the diagnosis, management and treatment of eye diseases. Our Optometric Eye Clinic offers the diagnosis, management and treatment of a wide range of eye diseases, including a wide range of eyewear.

POSITION SUMMARY

The Prior Authorization Specialist will report to the Revenue Cycle Manager and will focus on contributing to the procurement of medial authorizations for all Bloom Family Eye Center patients across various insurance levels. The Prior Authorization Specialist will also work closely with the revenue cycle team resolving claim denials and supporting the organization.

POSITION DUTIES AND RESPONSIBILITIES

· Responsible for requesting prior authorizations required based on insurance standards

· Responsible for reviewing documents to supplement the order to prove medical necessity

· Develop effective relationships at all levels, including patients and clinical teams, to resolve issues relating to missing vital information from patients’ record.

· Responsible for contacting the insurance carriers to obtain necessary prior authorizations

· Responsible for submitting all authorizations with correct CPT and diagnosis codes

· Maintain high level of patient confidentiality to ensure compliance with HIPAA regulations

· Communicate with management to resolve billing disputes and escalations

DESIRED TECHNICAL AND PROFESSIONAL SKILLS AND EXPERIENCE

· Minimum 2 years of experience in medical billing, eligibility, and customer service

· Knowledge of various health insurance programs preferred

· Knowledge of medical terminology and government and commercial rules and regulations

· Familiar with ICD 9/10 coding

· Ability to work in a large volume and fast past-paced environment

· Ability to meet goals in a timely manner in a deadline driven environment

· Strong problem-solving skills

· Knowledge of commercial and government healthcare billing regulations

· Minimum of 2 years of experience in NextGen EHR billing system

· Excellent verbal and written communication skills and attention to details

· Ability to work independently with minimal supervision

· Knowledge of Microsoft Office applications relating to Excel and Word documents

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Paid time off
• Retirement plan

Ability to Commute:

• Dayton, OH 45432 (Required)

Ability to Relocate:

• Dayton, OH 45432: Relocate before starting work (Required)

Work Location: In person

Salary : $18 - $22