Rev Cycle Specialist (Prior Authorization)

Key Responsibilities:

1. Prior Authorization Processing:

   • Initiate and manage prior authorization requests for ophthalmic treatments and medications.
   • Gather necessary medical documentation and clinical information to support authorization requests.
   • Ensure all authorization forms are completed accurately and submitted within specified timelines.

2. Communication and Coordination:

   • Communicate with insurance companies to advocate for timely approval of authorization requests.
   • Collaborate closely with healthcare providers, including ophthalmologists and clinical staff, to obtain required documentation and clinical justification.

3. Documentation and Compliance:

   • Maintain detailed records of all authorization requests, communications, and outcomes.
   • Ensure compliance with insurance regulations, policies, and guidelines related to prior authorizations.
   • Stay updated on insurance industry trends, policy changes, and procedural requirements affecting prior authorizations.

4. Quality Assurance and Efficiency:

   • Identify opportunities for process improvement and efficiency in prior authorization procedures.
   • Participate in training sessions to enhance knowledge of ophthalmic treatments and insurance protocols.
   • Contribute to a collaborative and supportive team environment within the ophthalmology practice.

Qualifications:

• Proven experience (3-5 years) in prior authorization processing within a healthcare setting, preferably in ophthalmology or a related field.
• Knowledge of medical terminology and familiarity with ophthalmic procedures, treatments, and medications.
• Strong understanding of insurance verification, authorization guidelines, and medical billing practices.
• Excellent communication skills (verbal and written) with the ability to interact professionally with healthcare providers, insurance representatives, and patients.
• Detail-oriented approach with exceptional organizational and time management abilities.
• Proficiency in using electronic health records (EHR) systems and prior authorization software.

Education:

• High school diploma or equivalent required. Associates degree preferred but not required
• Certification in medical billing, coding, or healthcare administration preferred but not required.

Working Conditions:

• This position is based in an office environmen.

• Benefits:

  • Competitive salary based on experience.
  • Health insurance benefits, retirement plans, and other applicable perks offered.
  • Opportunities for professional development and career advancement within the practice.