Prior Authorization Specialist

The Medical Eye Center P.C • Manchester, NH

454d • $39,083 - $39,915

About The Position

The Prior Authorization Specialist plays a crucial role in the Medical Eye Center by managing the prior authorization process for ophthalmic treatments and medications. This position requires a detail-oriented individual who excels in customer service and has a solid understanding of medical billing practices. The specialist will work primarily in an office environment, ensuring timely communication with insurance companies and healthcare providers to facilitate the authorization process. The role offers opportunities for professional growth and cross-training in other areas after a minimum training period.

Requirements

• High school diploma or GED.
• Minimum of 1-2 years in a medical-related field.
• 1-2 years of medical prior authorization experience preferred.
• Experience in Ophthalmology is a plus.
• Certification in medical billing, coding, or healthcare administration is preferred but not required.
• Knowledge of medical terminology and strong understanding of insurance verification and authorization guidelines.
• Superb time management and accuracy skills.
• Excellent verbal and written communication skills with attention to detail.
• Ability to display positive rapport and professionalism with coworkers, staff, supervisors, physicians, and patients.
• Proficiency in using electronic health records (EHR) systems and prior authorization software preferred.

Nice To Haves

• Certification in medical billing, coding, or healthcare administration.
• Experience in Ophthalmology.

Responsibilities

• 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 timely.
• Communicate with insurance companies to advocate for timely approval of authorization requests.
• Collaborate with healthcare providers to obtain required documentation and clinical justification.
• Maintain detailed records and ensure compliance with insurance regulations.
• Stay updated on insurance industry trends, policies, and changes affecting prior authorizations.
• Identify opportunities for process improvements and develop processes for reviewing provider schedules for financial arrangements and prior authorizations.
• Research and communicate with patients regarding insurance benefits and follow up on patient pre-pay balances.

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Paid time off
• Professional development assistance
• Referral program
• Retirement plan

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED