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. For more information, visit www.eyecare-partners.com

Job Title : Insurance Authorization Specialist

Must reside in the following states : AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NY, NJ, OH, OK, PA, TX, VA

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. 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 it 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.
• Adhere to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Perform 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

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.

Contact : (636) 227-2600

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.

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