Prior Authorization/Insurance Specialist

Talley Eye Institute•Evansville, IN

About The Position

The Insurance Specialist works in the Billing department and is responsible for injection authorizations, checking insurance benefits, and determining patients’ out-of-pocket expenses. The role involves coordinating with retina technicians, physicians, patients, payors, and other Revenue Cycle Management staff to investigate benefits, obtain prior authorizations, and connect patients with payment assistance programs. The specialist also helps patients with billing questions and supports improvements to benefits processes.

Requirements

High school diploma or equivalent.
At least two years of experience in a medical office; insurance experience is preferred.
Excellent written and verbal communication skills.
Strong organizational skills and attention to detail.
Excellent follow-up skills.
Ability to manage multiple tasks simultaneously.
Ability to work as a team player.

Nice To Haves

Insurance experience.

Responsibilities

Work with retina technicians and physicians to determine which medications patients can receive and which require samples or prior authorization.
Conduct thorough insurance benefits investigations when injections are recommended for treatment.
Obtain prior authorizations for injections when needed by contacting third-party payors via fax or other approved methods.
Communicate extensively by phone.
Work directly with patients and staff to enroll patients in payment assistance programs, including Good Days and CDF.
Coordinate with other Revenue Cycle Management staff to help ensure patients are not incorrectly billed for out-of-pocket expenses.
Work with administration and the supervisor to improve processes and reduce errors in benefits processing.
Assist front office personnel as necessary.
Answer the billing line when available to help patients with balances and other issues.
Perform other duties as assigned.