Pre-Authorizations Specialist

Vision Innovation Partners Support Center•Annapolis, MD

15h

About The Position

At Vision Innovation Partners, we exist to protect and restore vision. Because Vision is our Mission, everyone at VIP focuses on providing great patient outcomes and experiences. A career at VIP provides opportunities for growth and development, and a culture centered on our Shared Values – PATIENTS. The Pre-Authorization and Payment Collection Specialist will be working with the Surgical Coordinators and Scribes at our office locations to ensure that Pre-Authorizations are obtained through the patient’s insurance company for any clinic level procedure requiring such. This associate will coordinate with the office to collect payments from the patient prior to the scheduled surgery date. If authorization is denied or not obtained in the appropriate time frame, this associate will work with the office and the patient to reschedule the clinic level procedure to a time when the authorization is obtained. The associate will be looking ahead at the injection schedule and identifying patients who have not been enrolled in the drug assistance programs. The associate will coordinate with the scribes to ensure that any patient not enrolled will be enrolled in the appropriate program. The associate will be reconciling the monies collected via kiosk and manually cash and check. They will balance the kiosk close out twice a day and prepare the deposits for the bank. The associate will be available to answer insurance questions for the staff. The associate will manage the RCX Rules and Nextgen appointments without charges weekly.

Requirements

A high school diploma or GED equivalent is required.
Experience working in a medical billing environment and prior experience working with insurance companies to obtain pre-authorizations as required.
Experience communicating with patients about their financial obligations.
Understanding of Co-Insurance and Deductibles and the ability to explain these to a patient.
Skills necessary to efficiently operate various computer programs to assist in gaining authorizations and payments.
Proficiency in Nextgen, Clearwave, EMA, Excel, and Insurance Websites.

Responsibilities

Communicate and discuss with patients their financial obligations not covered by their insurance.
Manage large numbers of calls both incoming and outgoing daily.
Understand the pre-authorization requirements for surgical procedures.
Utilize Insurance company websites to obtain pre-authorizations in the most efficient manner.
Maintain accurate pricing of different lens upgrades at practices and surgical center locations.
Understand insurance deductibles and co-insurance requirements and be able to communicate to the patient why they are required to make these payments prior to surgery.
Make necessary changes to the patients' demographics and insurance information to obtain payment from the appropriate insurance company for both primary and secondary coverages.
Effectively use the Practice Management system (Nextgen) to accurately post the payments in the patient accounts.
Effectively work with multiple Surgical Coordinators at multiple practice locations to overcome any challenges with the patient's insurance, surgery schedule, upgrade conversions and all applicable payments required prior to surgery.
Makes corrections as needed to the patient's computer record so that future insurance claims and statements are accurate.
Communicates patient information in a manner that meets HIPAA requirements.
Extends courtesy and politeness to all customers and exercises tact and understanding.
Informs patients of financial responsibilities.
Prioritize high volumes of work and make necessary adjustments in daily work activities to keep up with any changes to surgery schedules, volume changes.
Work independently of others.
Communicate effectively and accurately any information that impacts the practice's ability to collect for services either from the insurance company or the patient.