Authorization and Billing Specialist

2 weeks ago


Brockton, Massachusetts, United States Ophthalmic Consultants Of Boston Full time
Job Title: Authorization and Billing Specialist

Ophthalmic Consultants of Boston is seeking a highly skilled Authorization and Billing Specialist to join our team in Plymouth. As a key member of our Retina team, you will play a critical role in providing administrative and billing support to our providers and clinical staff.

Key Responsibilities:
  • Maintain accurate and up-to-date knowledge of payer policies for Retina injectable medications, including policy changes as they occur.
  • Develop and maintain effective tracking tools for active Prior Authorizations (PA) and their expiration dates to anticipate PAs that need renewal.
  • Proactively submit PA requests and supporting documentation as needed for upcoming appointments with sufficient lead time to ensure PA approval prior to patients' appointments.
  • Communicate effectively with insurance companies to ensure prior approval and coverage.
  • Consistently and methodically save PA approval to patient records in Epic and update Permanent Comments fields to communicate status to providers and clinic teams.
  • Promptly and effectively address denied PAs to ensure approval is ultimately obtained.
  • Review periodic reports for outstanding patient balances to identify the need for connecting patients with copay support services.
  • Register commercially insured patients with manufacturer copay support services and Medicare and Medicare Advantage patients with foundation copay support services.
  • Order specialty pharmacy medication as required and communicate related billing procedures to clinic teams.
  • Manage and review the daily Epic schedule to ensure all scheduled retina/procedure appointments are verified for coverage, drug, authorization, and balance.
Requirements:
  • Associate degree in Business Administration or equivalent medical billing experience.
  • Bachelor's degree preferred.
  • 3+ years of medical billing experience.
  • Prior experience in ophthalmology strongly preferred.
  • Previous experience with Epic required.
What We Offer:

Ophthalmic Consultants of Boston offers industry-leading benefits, including a 401(k) plan and great medical and dental benefits. To learn more about our company, please visit our website.

We are an Equal Opportunity Employer.



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