Prior Authorization Specialist

Prior Authorization Specialist

For over two decades, Riverhills Neuroscience has been a pioneer in delivering exceptional neuroscience care. Our commitment to excellence extends across diagnosis, education, and treatment for those facing nervous system diseases and injuries.

Position: Prior Authorization Specialist

Location: Norwood Office

Department: Billing

Schedule: Monday-Friday, 8am-4:30pm, Hybrid, 2 days in office, 3 days remote after full in office training.

Pay: $18-22 per hour

Key Benefits for Full-Time Employees:

• Competitive pay based on experience, minimum $18
• 401k with Profit Sharing and 4% Company Match
• Comprehensive Medical, Dental, and Vision insurance
• Long-Term and Short-Term Disability Insurance
• Company Paid Life Insurance
• Paid Holidays
• Over three weeks of Paid Time Off
• Continuing Education Reimbursement
• Uniform Allowance
• Free Parking

Responsibilities:

• Streamline pre-certification, authorization, and referral processes, ensuring compliance with insurance requirements
• Coordinate with insurance entities, review organizations, and clinical contacts for effective communication and benefit determination
• Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients
• Ensure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin procedures
• Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet
• Initiate patient education on available assistance programs

Background and Experience:

• 1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice
• Pain Management experience is a plus
• 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 are a must, as are sound judgement, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendors

If you're eager to contribute to a world-class healthcare team, apply today. We look forward to welcoming dedicated professionals to contribute to the growth of our practice.

Equal Opportunity/Drug-Free Workplace:

Riverhills Neuroscience is an equal opportunity employer and maintains a drug-free workplace.