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Financial Authorization Specialist

2 months ago

Denver, Colorado, United States Colorado Retina Associates Full time
Job Overview

Position Title: Financial Authorization Specialist

Colorado Retina Associates stands as the leading retina clinic in the Rocky Mountain area, dedicated to delivering superior care and innovative treatments for our patients. We prioritize the well-being of our staff by offering competitive compensation, comprehensive benefits, and opportunities for professional growth alongside some of the most esteemed retina specialists in the nation.

This role is primarily based at our Parker office, with occasional responsibilities at other locations as required.

Note: Colorado Retina Associates adheres to the Covid-19 Vaccine Mandate. All employees must be vaccinated as a condition of employment, with accommodations available as necessary. Proof of vaccination or valid accommodation will be required upon hiring.

Compensation: $35.42 per hour

Employment Type: Full Time, Hybrid

Role Summary:

The Financial Authorization Specialist is responsible for ensuring that patient care can proceed without delay by performing essential tasks such as verifying insurance coverage, confirming referral requirements, and managing prior authorizations. This position involves reviewing patient accounts for accuracy, preparing Good Faith Estimates (GFEs), and facilitating payment collection.

This role collaborates closely with clinic staff, insurance providers, funding organizations, and patients.

Key Responsibilities:

  • Review patient appointment schedules to ensure accuracy in scheduling and insurance coverage.
  • Utilize eligibility systems and payer portals to confirm active insurance coverage.
  • Verify prior authorizations and referrals, ensuring that submitted diagnoses meet medical necessity criteria.
  • Document all actions in NextGen and manage appeals for denied prior authorization requests.
  • Input alerts and authorizations into NextGen and Nextech systems.
  • Submit benefits investigation requests to drug funding organizations.
  • Track paperwork processes to ensure timely decisions on co-pay assistance programs.
  • Review and correct patient account balances, providing explanations as needed.
  • Offer cost estimates and out-of-pocket expense information to patients.
  • Assist patients with payment arrangements and financial applications.
  • Maintain patient confidentiality at all times.
  • Demonstrate reliability and accountability in achieving departmental goals.

Qualifications:

  • High School Diploma or GED required.
  • Associate or Bachelor's degree preferred, or equivalent experience.
  • Minimum of two years' experience in a billing environment.
  • Strong background in customer service.

Preferred Skills:

  • Extensive knowledge of insurance authorizations and funding programs.
  • Proficient in navigating insurance eligibility.
  • Excellent communication skills and a positive demeanor.
  • Ability to make independent decisions and exercise discretion with patients and insurance.
  • Strong analytical and problem-solving abilities.
  • Effective verbal and written communication skills.
  • Familiarity with medical terminology and abbreviations.

Benefits Offered:

  • Competitive salary structure.
  • Safe harbor/profit sharing plan.
  • Comprehensive medical, dental, and vision insurance.
  • Pet insurance options.
  • Legal, life, accident, disability, and hospitalization insurance.