Job Details

ID #4196845
Estado South Carolina
Ciudad Northcharleston
Tipo de trabajo Full-time
Salario USD TBD TBD
Fuente Greenkey Resources
Showed 2020-06-30
Fecha 2020-06-22
Fecha tope 2020-08-21
Categoría Etcétera
Crear un currículum vítae

Prior Authorizations Specialist

South Carolina, Northcharleston 00000 Northcharleston USA

Vacancy caducado!

Job Description

The Prior Authorization Representative will focus on the coordination of the prior authorization process by responding to telephone inquiries and faxes from members and/or providers for ophthalmology services. The Prior Authorization Representative will assist with the coordination of durable medical equipment, and nonstandard eyewear and services authorization. They will also assist in the routine verification of eligibility and confirmation of benefits

  • Authorization of surgical requests according to set plan guidelines
  • Respond to telephone inquiries from members and/or providers for Optometry and Ophthalmology services as well as DME
  • Verification of eligibility, confirmation of benefits, facilitation of the referral/authorization processes
  • Direct communication with the Medical Director with regard to surgical authorizations and non-standard services
  • Preparation and coordination of denial letters
  • Assist with other duties as may be assigned
  • Create and maintain master spreadsheet to record all surgical procedures, denials, approvals

  • Review claims, insurances, and rejections to determine what type and if a follow up is required for a submitted claim
  • Work within computer-based work queues
  • Contact physician offices to obtain request for information (RFIs).
  • Coordinate and update prior authorization team with patient and provide communications

Qualifications

  • Must have 1-2+ years of experience as Prior Authorization Rep (ideally with a vision background)
  • Previous Optometry and/or Ophthalmology experience preferred
  • Authorization of surgical requests according to set plan guidelines

Additional Information

All your information will be kept confidential according to EEO guidelines.

Vacancy caducado!

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