Specialty Billing Pre-Authorization Representative

This position is eligible for Mid Atlantic Retina's $1,000 Hiring Incentive! The hired candidate will receive $500 after successful completion of 90 days of employment and $500 after successful completion of 1 year of employment! Available to new hires only- not available to agency hires, internal transfers, or re-hires.

Job Type: Full Time

Benefits: Medical, Dental, Vision, Paid Sick Time, Paid Vacation Time, 7 Paid Holidays and more

Job Description

This position is responsible for reviewing medical records and medical policies to obtain all necessary pre-authorizations and pre-determinations for patients to receive treatment with a medical drug injection.

Essential Functions

• Retrieves and reviews patient medical record from MDI to facilitate approval of pre-authorization or pre-determination submission.
• Submits pre-authorization or pre-determination to payer through their website or by calling them directly.
• Consistently follows up with payer to ensure all required documentation has been received. Researches and resolves any issues or errors.
• Navigates payer website to retrieve pre-authorization or pre-determination for injection patient.
• Monitors all assigned schedules in NextGen for add-ons and changes. Processes updates as needed.
• Recognizes, interprets, and evaluates inconsistencies, discrepancies, and inaccuracies in patient accounts along with system files, and initiates appropriate corrective methods.
• Maintain up to date billing knowledge of insurance carriers and their clinical policies pertaining to step therapy, authorizations, and covered diagnosis.
• Act as customer service representative in person or by telephone for any patient's questions about his/her account.
• Regular and predictable on-site attendance.
• Works overtime as needed.
• Travels to other MAR locations as needed.
• Performs other duties as assigned.

Competencies

• Problem Solving / Analysis - Creative problem solving within defined acceptable parameters. Identifies and resolves problems in a timely fashion.
• Customer Service- Superior listening skills, professional demeanor, and appropriate firmness.
• Conflict Resolution- Responds promptly to customer needs. Ability to handle difficult patient interactions relative to sensitive billing issues.
• Detail Oriented - Ensure proper procedures, protocols and processes are complied with consistently.
• Strong Interpersonal Skills- Works effectively with patients, employees, and physicians.
• Creative problem solving within defined acceptable parameters.
• Time Management- maintains high volume productivity level for essential functions.
• Ethical Conduct - Maintains confidentiality.

Required Education and Experience

• Benefit authorization experience preferred.
• Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals.
• Experience with CPT codes and ICD-10. Microsoft Office Suite required.