Prior Authorization Specialist

Riverhills Neuroscience; Cincinnati (OH); Hybrid; USD 25,000 - 30,000; Full time

Benefits offered by this job

401k with Profit Sharing

4% Company Match

Medical, Dental, Vision insurance

Disability Insurance

Life Insurance

Paid Holidays

Paid Time Off

Education Reimbursement

Uniform Allowance

Free Parking

Job summary

Riverhills Neuroscience is seeking a Prior Authorization Specialist to support the Billing department in Norwood. The role requires 1–2 years of medical billing and prior authorization experience, with EMR and insurance guideline knowledge.

The schedule is hybrid, with 2 days in-office and 3 days remote after training. Offered benefits include 401k with company match, comprehensive medical plans, paid time off, and education reimbursement.

Qualifications

• 1–2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice.
• Pain management experience is a plus.
• Experience with an EMR and practice management system.
• Knowledge of Medicare/Medicaid and major insurance carrier guidelines.
• Working knowledge of ICD-9-10 coding and medical terminology.
• Superior verbal and written communication skills are essential.

Responsibilities

• Streamline pre-certification, authorization, and referral processes to meet insurance requirements.
• Coordinate with insurance entities, reviewers, and clinical contacts for benefit determination.
• Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients.
• Ensure timely and accurate insurance authorizations and manage authorizations for botulinum toxin procedures.
• Monitor schedules for insurance coverage changes and oversee specialty pharmacy orders.
• Educate patients about available assistance programs.

Skills

Verbal communication

Written communication

EMR experience

Medical billing

ICD-9-10 knowledge

Tools

EMR system

Job description

About Us For over two decades, Riverhills Neuroscience has been a pioneer in delivering exceptional neuroscience care. Our commitment to excellence extends across diagnosis, education, and treatment for those facing nervous system diseases and injuries.

About Us For over two decades, Riverhills Neuroscience has been a pioneer in delivering exceptional neuroscience care. Our commitment to excellence extends across diagnosis, education, and treatment for those facing nervous system diseases and injuries.

Position

Prior Authorization Specialist

Location

Norwood Office

Department

Billing

Schedule

Monday-Friday, 8am-4:30pm, Hybrid, 2 days in office, 3 days remote after full in office training.

Pay

$18-22 per hour

Key Benefits For Full-Time Employees

• Competitive pay based on experience, minimum $18
• 401k with Profit Sharing and 4% Company Match
• Comprehensive Medical, Dental, and Vision insurance
• Long-Term and Short-Term Disability Insurance
• Company Paid Life Insurance
• Paid Holidays
• Over three weeks of Paid Time Off
• Continuing Education Reimbursement
• Uniform Allowance
• Free Parking

Responsibilities

As a Prior Authorization Specialist at Riverhills Neuroscience, you will play a vital role in ensuring the efficiency and accuracy of our billing processes. Your responsibilities include:

• Streamline pre-certification, authorization, and referral processes, ensuring compliance with insurance requirements
• Coordinate with insurance entities, review organizations, and clinical contacts for effective communication and benefit determination
• Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients
• Ensure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin procedures
• Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet
• Initiate patient education on available assistance programs

Background And Experience

• 1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice
• Pain Management experience is a plus
• Experience with an Electronic Medical Record (EMR) and practice management system
• Knowledge of Medicare/Medicaid and major insurance carrier's guidelines
• Working knowledge of ICD-9-10 medical coding and billing and medical terminology
• Superior verbal and written skills are a must, as are sound judgement, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendors

If you're eager to contribute to a world‑class healthcare team, we look forward to welcoming dedicated professionals to contribute to the growth of our practice.

Equal Opportunity/Drug-Free Workplace

Riverhills Neuroscience is an equal opportunity employer and maintains a drug‑free workplace.

Salary: $18 - $22 per hour