Rev Cycle Specialist

Key Responsibilities:Prior Authorization Processing: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 within specified timelines.Communication and Coordination:Communicate with insurance companies to advocate for timely approval of authorization requests.Collaborate closely with healthcare providers, including ophthalmologists and clinical staff, to obtain required documentation and clinical justification.Documentation and Compliance:Maintain detailed records of all authorization requests, communications, and outcomes.Ensure compliance with insurance regulations, policies, and guidelines related to prior authorizations.Stay updated on insurance industry trends, policy changes, and procedural requirements affecting prior authorizations.Quality Assurance and Efficiency:Identify opportunities for process improvement and efficiency in prior authorization procedures.Participate in training sessions to enhance knowledge of ophthalmic treatments and insurance protocols.Contribute to a collaborative and supportive team environment within the ophthalmology practice.Qualifications:Proven experience (3-5 years) in prior authorization processing within a healthcare setting, preferably in ophthalmology or a related field.Knowledge of medical terminology and familiarity with ophthalmic procedures, treatments, and medications.Strong understanding of insurance verification, authorization guidelines, and medical billing practices.Excellent communication skills (verbal and written) with the ability to interact professionally with healthcare providers, insurance representatives, and patients.Detail-oriented approach with exceptional organizational and time management abilities.Proficiency in using electronic health records (EHR) systems and prior authorization software.Education:High school diploma or equivalent required. Associates degree preferred but not requiredCertification in medical billing, coding, or healthcare administration preferred but not required.Working Conditions:This position is based in an office environmentRegular working hours, Monday to Friday, with occasional overtime as needed to meet deadlines or address urgent requests.Benefits:Competitive salary based on experience.Health insurance benefits, retirement plans, and other applicable perks offered.Opportunities for professional development and career advancement within the practice.Application Process:Interested candidates should submit a resume and cover letter detailing their relevant experience and qualifications.Interviews will be conducted with qualified applicants to assess fit for the role.

Created: 2024-11-07