Prior Authorization Revenue Cycle Specialist

Prism Vision Group; New Providence (NJ); On-site; USD 29,000 - 61,000; Full time

Job summary

Prism Vision Group is hiring a Revenue Cycle Specialist for our New Providence, NJ location. This on-site, non-exempt role focuses on billing and collecting from payors, ensuring accurate billing and compliance with regulations.

You will respond to inquiries from insurance carriers, pursue reimbursements, investigate denials, and manage patient payment plans. Experience with CPT/ICD-10 and Athenahealth is preferred.

Qualifications

• High School Diploma or GED with 3 years in a fast-paced medical billing environment.
• Familiarity with CPT and ICD-10; CPC certification is a plus.

Responsibilities

• Respond to inquiries from insurance carriers via phone, email or fax with strong customer service.
• Pursue reimbursement from carriers by calling and documenting communications in Athenahealth.
• Identify denials patterns and investigate to resolve issues.
• Review and resolve uncollected accounts and prepare charge corrections.
• Appeal carrier denials by reviewing coding, contracts, and medical records.
• Call insurers to resolve payment discrepancies when needed.
• Identify and bill secondary/tertiary insurances; research and appeal denied claims.
• Set up patient payment plans and verify benefit eligibility; research ICD-10/CPT codes.
• Report trends to management and assist with special projects.

Skills

Strong communication

Customer service

Problem solving

Time management

HIPAA knowledge

Medical terminology

Education

High School Diploma or GED

CPC certification (preferred)

Job description

Prism Vision Group is hiring a Revenue Cycle Specialist for our New Providence, NJ location. This on-site, non-exempt role focuses on billing and collecting from payors, ensuring accurate billing and compliance with regulations.

You will respond to inquiries from insurance carriers, pursue reimbursements, investigate denials, and manage patient payment plans. Experience with CPT/ICD-10 and Athenahealth is preferred.