Diagnostic & Authorization Advocate

Eye Care Partners Career Opportunities•Grand Rapids, MI

8d•Onsite

About The Position

The ideal candidate will have strong communication and computer skills, and as well as strong organization and attention to detail, to provide a positive impression, showing patients we provide unsurpassed care right from the start.

Requirements

High school diploma or general education degree (GED) required.
Previous medical office experience preferred.
Previous ophthalmic experience strongly preferred.
Professional in appearance and actions.
Logical and Critical thinking skills.
Customer-focused with excellent written, listening and verbal communication skills.
Enjoys learning new technologies and systems.
Detail oriented, professional attitude, reliable.
Exhibits a positive attitude and is flexible in accepting work assignments and priorities.
Meets attendance and tardiness expectations.
Management and organizational skills to support the leadership of this function.
Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations.
Interpersonal skills to support customer service, functional, and team mate support needs.
Able to communicate effectively in English, both verbally and in writing.
Ability for basic to intermediate problem solving, including mathematics.
Basic to intermediate computer operation.
Proficiency with Microsoft Excel, Word, and Outlook.
Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines.
Employees must be able to lift, carry, push, and pull items up to 25 lbs.
Strong fine motor skills and full use of hands are essential.
Constant grasping, writing/typing, hearing, and use of technology.
Visual and auditory acuity—including color, depth, peripheral vision, and the ability to adjust focus—is required 100% of the time.

Nice To Haves

Previous ophthalmic experience strongly preferred.

Responsibilities

Manage prior authorizations for medical procedures and treatments.
Assist patients with self-pay processes and understanding their financial responsibilities.
Handle Good Faith Estimates for services provided.
Process Patient Drug Assistance Applications to help patients afford their medications.
Provide backup support for template management and rescheduling of doctor's appointments.
Track all lab orders, receive and file lab results, and notify providers of new results.
Track all radiology orders, ensuring compliance with National Radiology Guidelines and Insurance Clinical Guidelines.
Verify that all necessary information, including specific ICD-10 codes, is included on imaging orders.
Collaborate with insurance portals and representatives to obtain necessary prior authorizations before sending imaging orders to radiology.
Update the Nextgen lab order module with current hospital laboratory compendium information.
Update the Nextgen radiology module with new tests as requested by providers.
Connect patients needing assistance with eye drops to available assistance or discount programs.
Provide patients with necessary information and initial applications for assistance programs.
Mail out annual renewal applications for assistance programs and ensure they are returned to the program coordinator.
Complete the provider portion of applications and obtain provider signatures.
Submit all necessary patient and provider paperwork to assistance programs.
Keep providers informed about new or discontinued drugs in assistance programs.
Research affordable alternative discount programs for patients not eligible for assistance or whose medications have been removed from programs.
Ensure received eye drops are sent to the patient's preferred pick-up location and notify patients.
Mail drops to patients if their circumstances prevent clinic pick-up.
Maintain detailed records of patient assistance participants, programs, and renewal dates.
Record which drops are shipped directly to patients and which are shipped to the practice.
Note which patients need to call for their own refills and which require the practice to order their drops.
Perform other duties as necessary for the organization.