Surgical Pre-Authorization/Benefits Specialist

This position is eligible for Mid Atlantic Retina's $1,000 Hiring Incentive! The hired candidate will receive $500 after successful completion of 90 days of employment and $500 after successful completion of 1 year of employment! Available to new hires only- not available to agency hires, internal transfers, or re-hires.

Job Type: Full Time

Sign On Bonus Eligible: Yes

Job Description

The Surgical Pre-Authorization/Benefits Specialist is responsible for verifying benefits and obtaining authorizations/referrals as they pertain to surgical procedures.

Required Education and Experience

1. 1-3 years of benefit eligibility and authorization experience preferred.
2. Knowledge of benefit investigation which include obtaining eligibility information, authorizations and referrals.
3. Experience with CPT codes, ICD-10 and the Microsoft Office Suite. NextGen a plus.
4. Strong customer service skills and attention to detail.

Essential Functions

1. Reviews chart documentation to ensure patient meets medical policy guidelines.
2. Prioritizes incoming authorization/benefit requests according to urgency.
3. Timely and accurately obtain authorization/benefits via payer website or by phone and follows up regularly on pending cases. This includes obtaining retro authorizations as needed.
4. Obtains referrals if required by patients' insurance.
5. Communicates with the surgical coordinators and surgical billers. Provides updates relating to precertification delays.
6. Interacts with clients, insurance companies and patients as necessary
7. Maintains individual payer files to include up to date requirements needed to successfully obtain authorizations/benefits.
8. Initiates appeals for denied authorizations.
9. Responds to clinic questions regarding payer medical policy guidelines.
10. Confirms accuracy of CPT and ICD-10 diagnoses in the procedure order.
11. Keeps current with all medical policies as they pertain to our practice.
12. Regular and predictable on-site attendance required.
13. Performs other related duties as required and assigned.
14. Travels to other MAR locations as needed.

Physical and Cognitive Demands

The physical and cognitive demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

1. This is largely a sedentary role; however, some filing may be required. This would require the ability to occasionally lift files, bend, stoop, crouch, reach, and stand on a stool as necessary.
2. Ability to lift or move up to 15 pounds at times.
3. Work with data by calculating and manipulating numbers, processing data on a computer, classify, record, store and retrieve information.
4. Use words to communicate ideas, read with comprehension and explain abstract or complex ideas in more basic terms.
5. The employee will use hands to operate equipment such as a computer mouse, show manual or finger dexterity, handle things with precision or speed, use muscular coordination and physical stamina.
6. While performing the duties of this job, the employee is regularly required to talk, communicate verbally one to one, in front of groups, over the telephone or with a headset and in email.
7. This position requires listening to verbal communication using a telephone or with a headset and processing the information while entering the data into a computer system, processing auditory information and responding verbally back in an appropriate manner.
8. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus with or without corrective lenses.
9. Ability to follow through on plans or instructions.

Salary : $500