Rev Cycle Specialist (Prior Authorizations)

Role and Responsibilities:

• Identifies all appointments and procedures that require prior-authorization by monitoring system reports
• Reviews patient diagnoses and medical notes/laboratory reports required for prior-authorizations submissions
• Accountable for knowledge of updated drug and procedure prior-authorization requirements, relating to all commercial insurance carriers
• Communicates with Insurance carriers by phone for cases of urgency, down systems, research/clarifications or troubleshooting
• Independently maintains and updates multiple reports on all upcoming patient appointments and prior-authorizations
• Maintains patient confidentiality
• Utilizes insurance portals to submit prior-authorizations
• Troubleshoots prior-authorization cases for insurances
• Manages a high-volume demand for prior-authorizations with accuracy
• Attends and participates in NJ Retina / or payer meetings/seminars as needed
• Maintains open, positive cordial, team-oriented lines of communications with managers and staff members
• Contributes to the Business office team thought, positive attitude, respectful interaction, innovative ideas and efficiently
• Other duties as assigned

Essential Qualifications:

Education: High School Diploma or equivalent; Bachelor’s degree preferred.

Experience: 1 years’ experience in an administrative role; medical billing experience within Ophthalmology preferred but not required.

Knowledge/Skills/Experience:

• Working knowledge of prior-authorization process

• Experience with Medicare, insurances, claims, appeals
• Knowledge of CPT, ICD-9 and/or ICD-10 codes a plus
• Proven customer service skills
• Able to work in a high volume/fast-paced environment
• Excellent written and verbal communication skills
• Outstanding attention to detail and excellent time management skills
• Outstanding typing and computer skills with billing software, Microsoft Word and Microsoft Excel
• Ability to work with sensitive and confidential information