Our Insurance Authorizations Specialist plays a crucial role in ensuring the seamless processing of patient insurance claims. Responsibilities include verifying patient insurance coverage, obtaining pre-authorization for medical procedures and treatments, and effectively communicating with insurance providers to resolve authorization-related issues. This position requires strong attention to detail, excellent communication skills, and a deep understanding of medical insurance protocols.
- Verifies member’s eligibility and benefits with subsequent notification to designated staff of eligibility issues
- Handle Authorization submissions and follow-ups for all Insurance Payors including Medicare, Medicaid, HMO, and PPO’s
- Ensure that all assigned Authorizations are resolved within appropriate time restraints
- Researches and documents coverage determination requests for prior authorization (PA) by independently researching the EMR chart notes and historical clinical data and diagnosis, in order to identify prior to appointment.
- Works closely with and supports team efforts to accomplish authorization
- management software, via telephone or online using insurance eligibility portals.
- Request authorizations form insurances for upcoming / existing appointments.
- Enter in referrals / authorizations information in practice management software.
- Maintain accurate and current insurance files.
- Follow and maintain data integrity protocols in adding / editing patients insurance record.
- Knowledge of PPO and HMO insurances.
- Answers questions of authorization requirements for all payers to assist clinical and front office staff.
- Submit appeals and request reconsideration on authorization denials.
- Speak to patients regarding changes in their insurance eligibility or authorization status.
- Speak to insurance companies directly regarding eligibility, authorizations, and appeals.
- Speak to referring physicians.
- Ability to read chart notes in our EMR system.
- Adheres to all HIPAA regulations.
- Medical Insurance Plans
- Vision Insurance Plan
- Dental Insurance Plan
- 401K Contribution
- Life Insurance
- Sick, Vacation, and Holiday Pay
- Certification Opportunities
About the Candidate
- Excellent verbal and written communication skills.
- Ability to multitask.
- Ability to work independently and as a team.
- Proactive in their work.
- Ability to learn NextGen, MDI EMR, and basic ICD-10 codes
Who We Are
California Retina Consultants (CRC) is part of Retina Consultants of America (RCA), the largest network of leading retina specialists with the mission of saving sight and improving patient lives through innovation and the highest quality care. Through RCA's physician-centered practice management model, physicians continue to drive clinical and practice culture while benefiting from the available business expertise, resources and shared best practices.
Equal Opportunity Employer
California Retina Consultants is proud to be an Equal Employment Opportunity and an Affirmative Action Employer. We are committed to creating an inclusive work environment that celebrates diversity.
All offers are contingent upon satisfactory background check and pre-employment drug screen.