Prior Authorization Specialist

Riverhills Neuroscience•Cincinnati, OH

7d•$18 - $22•Hybrid

About The Position

For over two decades, Riverhills Neuroscience has been a pioneer in delivering exceptional neuroscience care. Our commitment to excellence extends across diagnosis, education, and treatment for those facing nervous system diseases and injuries. As a Prior Authorization Specialist at Riverhills Neuroscience, you will play a vital role in ensuring the efficiency and accuracy of our billing processes. Your responsibilities include: Streamline pre-certification, authorization, and referral processes, ensuring compliance with insurance requirements Coordinate with insurance entities, review organizations, and clinical contacts for effective communication and benefit determination Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients Ensure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin procedures Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet Initiate patient education on available assistance programs

Requirements

1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice
Experience with an Electronic Medical Record (EMR) and practice management system
Knowledge of Medicare/Medicaid and major insurance carrier's guidelines
Working knowledge of ICD-9-10 medical coding and billing and medical terminology
Superior verbal and written skills are a must, as are sound judgement, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendors

Nice To Haves

Pain Management experience is a plus

Responsibilities

Streamline pre-certification, authorization, and referral processes, ensuring compliance with insurance requirements
Coordinate with insurance entities, review organizations, and clinical contacts for effective communication and benefit determination
Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients
Ensure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin procedures
Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet
Initiate patient education on available assistance programs