RCM/OPH Insurance Authorization Specialist

RCM/OPH Insurance Authorization Specialist

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.

Job Title: Insurance Authorization Specialist

Hybrid- 3 days in office 2 days remote. Can be remote after training.

Job Summary

The Intake Specialist Insurance Authorization is responsible for timely, accurate and comprehensive review of patient schedules. Coordinates and effectively communicates with appropriate personnel regarding insurance carriers, business office services to ensure quality patient care and appropriate reimbursement. Also obtains the appropriate Pre-Authorization and Referral information, including verification of patient insurance, from physician offices and insurance carriers.

Duties and Responsibilities

• File requests for prior authorization for all insurances that require based upon plan or insurance contract
• Request, obtain, and document all prior authorizations (or denials of same) appropriately and in a timely manner
• Obtain information about patient insurance coverage, benefits and eligibility
• Maintain and update internal listing of insurance carriers that require authorization
• Run system-generated reports to verify procedures by insurances requiring authorization are being captured
• Assist collection team with obtaining retro authorizations
• Coordinate with Call Center and Optical Offices on prior authorization and patient billing activity
• Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Education, Licensure & Certification Requirements

High School Diploma or GED

Experience Requirements

2+ years' experience medical authorizations

Knowledge, Skills and Abilities Requirements

Comprehensive understanding of insurance verification, contract benefits and medical terminology

Ability to enter data into various electronic systems while maintaining the integrity and accuracy of the data

Ability to function effectively under stress of conflicting demands on time and attention, while successfully meeting deadlines

Excellent organization, time management, and prioritization skills

Professional in appearance and actions

Logical and Critical thinking 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 teammate support need

Able to communicate effectively in English, both verbally and in writing

Ability to clearly articulate a response using appropriate voice modulation

Ability to maintain control of a call de-escalating issues and instilling confidence that a resolution will be found

Ability for basic to intermediate problem solving, including mathematics

Basic to intermediate computer operation

Proficiency with Microsoft Excel, Word, PowerPoint and Outlook

Specialty knowledge of systems relating to job function

Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Location/Work Environment: For on-site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards. For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.