Prior Authorization/Insurance Specialist

 

POSITION:              Insurance Specialist 

DEPARTMENT:      Billing 

REPORTS TO:        Billing Manager

Job Summary:       This individual is responsible for injection authorization, checking insurance benefits, and out of pocket expenses. 

 

Education and Experience: 

1.    High school diploma or equivalent. 

2.    Two years minimum experience in medical office, insurance experience preferred. 

Essential Skills and Abilities: 

1.    Excellent communication skills, written and oral. 

2.    Strong organization skills with attention to detail. 

3.    Excellent follow-up skills. 

4.    Management of multiple tasks simultaneously. 

5.    Ability to work as a team player. 

RESPONSIBILITIES: 

1.    Injection authorizations: 

a.    Works with retina technicians and physicians on determining which medications the patient can have vs. which ones will require a        sample or prior authorization. 

b.    Performs a thorough benefits investigation on patients when injections are recommended for treatment. 

c.    If needed, obtain prior authorizations for injections by contacting third party payors via fax or other TEI approved methods. 
d.    Heavy phone contact communication. 

2.    Patient assistance programs 

a.    Work directly with patients and staff to get patients signed up for payment assistance programs, including Good Days, CDF, etc. 

b.    Enroll patients in assistance programs as needed. 

c.    Work with other individuals in RCM department to ensure that patients are not erroneously billed for out-of-pocket expense. 

3.    Additional Duties

a.    Work with administration and supervisor to look for ways to make processes work more smoothly and reduce the opportunity for errors          in the benefits process. 

b.    Assist front office personnel as necessary 

c.     Answer billing line when available to help patients with balances and other issues 

d.    Other duties as assigned.

Excellent Benefits 

Salary commensurate with experience.