Prior Authorization Specialist

Job Description

Job Description

JOB SUMMARY: Southern Vitreoretinal Associates (SVA) is seeking a Prior Authorization Specialist , to join our Tallahassee, FL team. SVA is an Ophthalmology practice that specializes in retina care. We have six offices and six physicians. The ideal candidate will thrive in a fast-paced environment, exhibit exceptional attention to detail, and demonstrate the ability to manage multiple priorities with urgency and accuracy. Under general supervision of the Assistant Business Office Manager, the Prior Authorization Specialist is responsible for all tasks from clinic and the schedules in a timely manner, including but not limited to approvals, authorizations, and call for approval list. Job functions must be completed with a minimum number of errors and are subject to routine quality reviews. This individual will also be responsible for assisting with other areas as necessary.

PRIMARY AREAS OF RESPONSIBILITIES: The duties identified below are the essential functions of the position. Reasonable accommodation 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. May call the patient when necessary to obtain current information needed to correctly verify the patient's insurance and benefits.
4. Work same day drug approvals.
5. 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.
6. Assists with Patient Financial Funding applications and obtaining the funding assistance the patient needs to complete their treatment.
7. Enters appropriate account notes into NextGen system, documenting actions taken, with the expected end results.
8. Person will be working in the business office as well as rotating shifts in our clinic next door.

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.

EXPECTATIONS:

1. Reinforces and abides by SVA’s core values.
2. Ensures high level of customer service, compassionate, patient-centered care to patients.
3. Collaborates across the organization to develop, implement, and maintain processes that positively impact the revenue cycle.

1. Understands and complies with all laws, rules, regulations, policies, and procedures applicable to the position
2. Utilizes a variety of office technology, to capture and document services provided, ensuring an accurate billing record.

1. Excellent written, verbal and presentation skills necessary to facilitate accurate communication with providers and staff, providing a consistent message.
2. Strong organizational skills and attention to detail with accuracy in all tasks
3. Proficiency with office software and medical management systems is preferred.
4. Ability to work well under pressure, maintaining a calm and professional demeanor.

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.

Working Environment:

1. Fast-paced, high-energy environment requiring attention to detail and quick decision-making.

1. Must be able to manage multiple tasks simultaneously while ensuring quality and patient satisfaction.
2. Prolonged periods of sitting and working on computers and on the phone
3. Full-time position: Work hours are Monday through Friday. Typically,8:00am – 5:00pm with one night closing until 6:00pm on a rotational basis.

1. This person must be willing to work on-site, in-office, NO REMOTE WORK will be available.

Why Join Us:

This position offers unparalleled opportunities to learn and grow within a supportive team environment. You'll be challenged daily, allowing you to expand your skill set and make meaningful contributions to our patients' well-being. If you're ready to take your career to the next level and thrive in a role that values empathy and expertise, we invite you to apply and become part of our dynamic team today.

Pay and Benefits:

• Starting pay is $16-18 per hour
• Full time employees offered Health with HSA, Vision, EAP, Dental, Life Insurance, 401K matching, Profit Sharing, PTO and Paid Holidays

*EEOC and ADA Disclaimer: Southern Vitreoretinal Associates is an Equal Opportunity Employer. Employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodation will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Southern Vitreoretinal Associates retains the right to change or assign other duties to this position.