Specialty Billing Pre-Authorization Representative

Mid Atlantic Retina•Bethlehem, PA

2d•Onsite

About The Position

This position is responsible for reviewing medical records and medical policies to obtain all necessary pre-authorizations and pre-determinations for patients to receive treatment with a medical drug injection.

Requirements

Benefit authorization experience preferred.
Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals.
Experience with CPT codes and ICD-10.
Microsoft Office Suite required.

Nice To Haves

Creative problem solving within defined acceptable parameters.
Superior listening skills, professional demeanor, and appropriate firmness.
Responds promptly to customer needs. Ability to handle difficult patient interactions relative to sensitive billing issues.
Ensure proper procedures, protocols and processes are complied with consistently.
Works effectively with patients, employees, and physicians.
Maintains high volume productivity level for essential functions.
Maintains confidentiality.

Responsibilities

Retrieves and reviews patient medical record from MDI to facilitate approval of pre-authorization or pre-determination submission.
Submits pre-authorization or pre-determination to payer through their website or by calling them directly.
Consistently follows up with payer to ensure all required documentation has been received. Researches and resolves any issues or errors.
Navigates payer website to retrieve pre-authorization or pre-determination for injection patient.
Monitors all assigned schedules in NextGen for add-ons and changes. Processes updates as needed.
Recognizes, interprets, and evaluates inconsistencies, discrepancies, and inaccuracies in patient accounts along with system files, and initiates appropriate corrective methods.
Maintain up to date billing knowledge of insurance carriers and their clinical policies pertaining to step therapy, authorizations, and covered diagnosis.
Act as customer service representative in person or by telephone for any patient's questions about his/her account.
Regular and predictable on-site attendance.
Works overtime as needed.
Travels to other MAR locations as needed.
Performs other duties as assigned.