Diagnostic & Authorization Advocate

Job Description

Job Description

EyeCare Partners is the nation's leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit

Company: Grand Rapids Ophthalmology
Job Title: Diagnostic Advocate
Department: Ophthalmology
Reports To: Clinic Supervisor
Location: This position is located in Grand Rapids, MI

SUMMARY

The ideal candidate will have strong communication and computer skills, and as well as strong organization and attention to detail, to provide a positive impression, showing patients we provide unsurpassed care right from the start.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Prior Authorizations

• Assistance with Self-pay processes

• Good Faith Estimates

• Patient Drug Assistance Applications

• Back up template management/reschedules for doctors

• Keep track of all lab orders, lab results, file results to EMR's notify providers of new results as they are reported and scanned to the chart.

• Keep track of all radiology orders. Ensure the ordered imaging complies with both National Radiology Guideline and Insurance Clinical Guidelines.

• Ensure all necessary information is included on each imaging order, ICD-10 codes are specific/descriptive for the clinical tests results related to imaging that is ordered.

• Work with insurance prior-authorization portals and/or prior-authorization representatives and nurse reviewers to successfully obtain all necessary insurance prior authorizations prior to sending the imaging orders to radiology central scheduling.

• Update the Nextgen lab order module as needed to stay current with the hospital laboratory's compendium.

• Update the Nextgen radiology module with new test as requested by providers.

• Connect patients in need of assistance in affording their eye drops, to an available assistance or discount program, if possible.

• Provide them with necessary information and the initial application for that program.

• Mail out renewal applications annually for as long as they remain on the drop. The assistance program will determine eligible. All applications should mailed to the patient along with a self-addressed envelope so they can return to application to the program coordinator.

• Complete provider portion of application and have the provider sign the application. • Submit all information necessary patient and provider paperwork to the assistance program, to give the patient the best chance of qualifying for the program.

• Keeping the providers informed when new drugs become available or is removed from an assistance program.

• Research affordable alternative discount programs for patients not eligible for an assistance program or for whom their medication has been removed from an assistance program.

• Ensure all drops that are required to be shipped to the primary clinic location, are received and sent to the patient's preferred pick-up location and patient notified that their drops are available for pick up at that 2 location. If patients' circumstances prevent them being able to pick up their drops at a clinic location, mailing the drops is permitted.

• Keep detailed records on all patient assistance participants, the program, or programs they are on and when their application must be renewed.

• Keep a record of whose drops are shipped directly to the patient and which drops are shipped the practice. Make note of patients who are to call for their own refills and which patients need their drops ordered by the practice.

• Performs other duties that may be necessary or in the best interest of the organization.

Patient Population Served (For nursing / patient care positions):

• Team members will work with patients of all ages, races, and genders.

EDUCATION AND/OR EXPERIENCE

• Minimum Required: High school diploma or general education degree (GED) required
• Previous medical office experience preferred; previous ophthalmic experience strongly preferred.

KNOWLEDGE, SKILLS and ABILITIES:

• Professional in appearance and actions
• Logical and Critical thinking skills
• Customer-focused with excellent written, listening and verbal communication skills
• Enjoys learning new technologies and systems • Detail oriented, professional attitude, reliable
• Exhibits a positive attitude and is flexible in accepting work assignments and priorities
• Meets attendance and tardiness expectations
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and team mate support need o Able to communicate effectively in English, both verbally and in writing
• Ability for basic to intermediate problem solving, including mathematics
• Basic to intermediate computer operation
• Proficiency with Microsoft Excel, Word, and Outlook
• Travel to other site locations may be necessary. Thus, those needing to travel for work must have access to dependable transportation, and driving record must meet company liability carrier standards
• Specialty knowledge of systems relating to job function
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

PHYSICAL REQUIREMENTS

• This role requires a variety of physical activities to effectively perform essential job functions. The position involves frequent walking (75%), sitting (50%), and standing (50%), with regular bending, stooping, carrying, and reaching (25–50%). Employees must be able to lift, carry, push, and pull items up to 25 lbs. Strong fine motor skills and full use of hands are essential, as the role demands constant grasping, writing/typing, hearing, and use of technology. Visual and auditory acuity—including color, depth, peripheral vision, and the ability to adjust focus—is required 100% of the time. Occasional driving or climbing may also be necessary.

If you need assistance with this application, please contact View phone number on ziprecruiter.com. Please do not contact the office directly – only resumes submitted through this website will be considered.

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.