Prior Authorization Specialist
$37,440–$45,760 year
HybridCincinnati, Ohio, United States
Job Summary
Streamline pre-certification, authorization, and referral processes while coordinating with insurance entities, review organizations, and clinical contacts for benefit determination. Facilitate peer-to-peer reviews for escalated encounters, ensure timely insurance authorizations, and manage authorizations for botulinum toxin procedures. Monitor schedules for coverage changes, oversee specialty pharmacy orders, and maintain the ordering spreadsheet. Initiate patient education on available assistance programs. This role supports Riverhills Neuroscience's commitment to excellence in diagnosis, education, and treatment for nervous system diseases and injuries.
Required Qualifications
- 1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice
- Experience with an Electronic Medical Record (EMR) and practice management system
- Knowledge of Medicare/Medicaid and major insurance carrier's guidelines
- Working knowledge of ICD-9-10 medical coding and billing and medical terminology
- Superior verbal and written skills
- Sound judgement
- Maturity
- The ability to establish good rapport with employees, patients, physicians, and vendors
- Monday-Friday, 8am-4:30pm, Hybrid, 2 days in office, 3 days remote after full in office training
Desired Qualifications
- Pain Management experience
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