Surgical Pre-Authorization/Benefits Specialist

Mid Atlantic Retina • Plymouth Meeting, PA

55d • Onsite

About The Position

The Surgical Pre-Authorization/Benefits Specialist is responsible for verifying benefits and obtaining authorizations/referrals as they pertain to surgical procedures.

Requirements

• 1-3 years of benefit eligibility and authorization experience preferred.
• Knowledge of benefit investigation which include obtaining eligibility information, authorizations and referrals.
• Experience with CPT codes, ICD-10 and the Microsoft Office Suite.
• Strong customer service skills and attention to detail.

Nice To Haves

• NextGen a plus.

Responsibilities

• Reviews chart documentation to ensure patient meets medical policy guidelines.
• Prioritizes incoming authorization/benefit requests according to urgency.
• Timely and accurately obtain authorization/benefits via payer website or by phone and follows up regularly on pending cases. This includes obtaining retro authorizations as needed.
• Obtains referrals if required by patients' insurance.
• Communicates with the surgical coordinators and surgical billers. Provides updates relating to precertification delays.
• Interacts with clients, insurance companies and patients as necessary
• Maintains individual payer files to include up to date requirements needed to successfully obtain authorizations/benefits.
• Initiates appeals for denied authorizations.
• Responds to clinic questions regarding payer medical policy guidelines.
• Confirms accuracy of CPT and ICD-10 diagnoses in the procedure order.
• Keeps current with all medical policies as they pertain to our practice.
• Regular and predictable on-site attendance required.
• Performs other related duties as required and assigned.
• Travels to other MAR locations as needed.

Benefits

• This position is eligible for Mid Atlantic Retina's $1,000 Hiring Incentive! The hired candidate will receive $500 after successful completion of 90 days of employment and $500 after successful completion of 1 year of employment! Available to new hires only- not available to agency hires, internal transfers, or re-hires.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: No Education Listed
• Number of Employees: 101-250 employees