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Prior Authorization Specialist

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Tallahassee, United States Southern Vitreoretinal Full time
Job DescriptionJob Description

JOB SUMMARY: Southern Vitreoretinal Associates (SVA) Prior Authorization Specialist, under direction of the Assistant Business Office Manager, will work all tasks from clinic and the schedules in a timely manner, including but not limited to approvals, authorizations, and call for approval list.

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.

ACCOUNTABILITIES:

  1. Meets or exceeds Key Performance Indicators (KPI’s) that are relevant to the work assigned so that SVA achieves best practice measures for Revenue Cycle.
  2. Facilitates the rapid and successful conversion of insurance revenue into cash, minimize debt, improve cash flow and manage overall health of account receivables.

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.