Insurance Department - Tallahassee, United States - Southern Vitreoretinal

Description

Job Description

Southern Vitreoretinal Associates (SVA) Prior Authorization Specialist, under direction of the Assistant Business Office Manager, is responsible for obtaining approval for treatments prior to the patient's appointment date. The Prior Authorization Specialist will also confirm approvals for same day procedures and injections when they arise. This is a full-time position, 40 hours per week, Monday through Friday.

PRIMARY AREAS OF RESPONSIBILITIES: The duties identified below are the essential functions of the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned that align with the summary of this position.

1. Works offices as assigned, to obtain prior authorizations needed for scheduled appointments, procedures and injections, as needed for treatment of SVA patients. Follows the SVA policies and timing regarding obtaining prior authorizations as needed.
2. Assist patient with applying for funding assistance to help cover the cost of their drugs needed for treatment.
3. Work same day drug approvals
4. Create next day Call for Approvals List to send to the clinic managers, assistant managers, team lead and front desk for all offices, so the clinics can take appropriate action regarding the patients upcoming treatment.
5. Assists with Patient Financial Funding applications and obtaining the funding assistance the patient needs to complete their treatment.
6. Enters appropriate account notes into NextGen system, documenting actions taken, with the expected end results.

EDUCATION AND EXPERIENCE:

1. High School diploma or equivalent.
2. Well organized and detail oriented.
3. Working knowledge/experience with EHR/medical billing software.
4. Understanding of private insurance rules and regulations.