Patient Care Billing & Authorization Specialist

Patient Care Billing & Authorization Specialist
We are a thriving and patient-centered ophthalmology practice dedicated to providing exceptional eye care and a positive patient experience. We are looking for a detail-oriented and versatile professional to join our team in a multi-faceted role that combines responsibilities in billing, insurance authorization, and front office coordination.

Position Summary
As the Patient Care Billing & Authorization Specialist, you will play a pivotal role in ensuring the seamless operation of our practice, supporting both the financial and administrative aspects of patient care. This role bridges the gap between patients, providers, insurance carriers, and third-party billing partners, helping to create an engaging and efficient office environment.

Primary Responsibilities

Billing & Revenue Management:

• Partner with third-party billing services to ensure the prompt and accurate processing of payments.
• Process daily payments from both patients and insurance providers, reconciling accounts and preparing bank deposits.
• Oversee internal billing functions, including co-management accounts and follow-ups on outstanding balances.
• Coordinate pre-payment processes for surgical procedures and specialty services when necessary.

Insurance Authorization & Verification:

• Handle insurance pre-authorizations for visits, diagnostic exams, procedures, and surgeries.
• Confirm patient insurance eligibility and benefits, ensuring all necessary records are up to date.
• Maintain organized authorization records within electronic health record (EHR) systems.
• Act as a point of contact for insurance providers, referring offices, and patient inquiries related to authorizations.

Front Office Administration & Patient Interaction:

• Assist reception staff by greeting patients, managing check-ins and check-outs, and ensuring a welcoming atmosphere.
• Facilitate scheduling of appointments, confirmations, and follow-ups on cancellations and no-shows.
• Collect co-pays, update patient demographics, and verify insurance information to ensure accurate records.
• Provide general support to front office operations to maintain a smooth workflow throughout the day.

Medical Records Maintenance:

• Organize and scan patient documentation to maintain comprehensive EHR records.
• Verify the accuracy of CPT coding, patient charting, and claims data to ensure compliance.
• Adhere to HIPAA and PHI standards, safeguarding patient confidentiality at all times.

Qualifications

• A minimum of 2 years' experience in medical billing, insurance authorizations, or front office administration (experience in ophthalmology is a plus).
• Proficiency with electronic health record (EHR) systems such as Nextech or EPIC is strongly preferred.
• Thorough understanding of authorization processes, insurance verification, and billing procedures.
• Outstanding organizational skills, multitasking abilities, and attention to detail.
• Strong interpersonal and communication skills, with a focus on providing excellent patient care.
• Commitment to confidentiality and compliance with HIPAA regulations.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.