Prior Authorization Specialist

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

Benefits offered by this job

Competitive pay

401k with profit sharing

Medical, Dental, Vision insurance

Long-Term and Short-Term Disability

Company Paid Life Insurance

Paid Holidays

Paid Time Off

Continuing Education Reimbursement

Uniform Allowance

Free Parking

Job summary

Riverhills Neuroscience is seeking a Prior Authorization Specialist for our Norwood Office in the Billing department. The role supports pre-certifications, referrals, and insurance communications in a hybrid schedule with two days in office and three days remote after training.

You will coordinate with insurers, perform benefits investigations, and manage authorizations for botulinum toxin procedures while ensuring accuracy, compliance, and strong patient service throughout the process.

Qualifications

• 1–2 years of medical billing and/or prior authorization experience in a healthcare practice.
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Responsibilities

• Streamline pre-certification, authorization, and referral processes to meet 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 and conduct benefits investigations, including botulinum toxin procedures.
• Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain ordering spreadsheets.
• Initiate patient education on available assistance programs.

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.

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

Equal Opportunity/Drug-Free Workplace

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

Salary: $18 - $22 per hour