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Prior Authorization/Insurance Specialist-REMOTE (Ophthalmology Experience Required)

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An opthalmology (retina only specialty ) practice is seeking an experienced Remote Prior Authorization Specialist to join our team. The core of this role is responsibility for managing and submitting prior authorizations for retinal procedures, including injection drugs, surgery, laser, exams, or any other types of procedures. Other parts of the role is managing medication assistance program funds, medication inventory system managment, etc. The ideal candidate will have a strong understanding of insurance requirements, excellent attention to detail, and current or prior experience submitting and manageing authorizations for a retina practice.

Responsibilities:

  • Submit and manage prior authorization requests for retinal injections, procedures, imaging, and medications
  • Communicate with insurance companies to verify coverage and authorization requirements
  • Follow up on PA denials and appeals
  • Track authorization status and follow up on pending requests
  • Work closely with clinical staff and providers to ensure timely patient care
  • Maintain accurate documentation within the EHR system
  • Identify and resolve authorization denials and assist with appeals when necessary
  • Stay current with payer policies and prior authorization guidelines
  • Some scheduling, answering phones, or other adminstrative tasks may be required
  • Work with medication inventory systems
  • Work with patient assistance funding programs on behalf of our patients

Qualifications:

  • Required: Prior authorization experience in a Retina Practice (or multi speciality eye practice that included Retina)
  • Positive interactions and communication skills amongst staff
  • Strong knowledge of insurance plans, payer requirements, and medical terminology
  • Experience with specialty medications and procedure authorizations
  • Ability to manage multiple authorizations and meet deadlines in a fast-paced environment
  • Strong communication and organizational skills
  • Experience with electronic health records (EHR)
  • Ability communicate effectively and positively with clinical staff, physician, and management

Pay: $18.00 - $23.00 per hour

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Flexible schedule
  • Flexible spending account
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Vision insurance

Application Question(s):

  • Ability to communicate in a professional and customer service oriented manner
  • Work effectively and maintain work standards in a remote/work from home environment

Experience:

  • Retina specific Prior Auth: 1 year (Required)

Language:

  • Professional/Business English clearly and effectively (Required)

Ability to Commute:

  • Remote (Preferred)

Work Location: Remote

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