Prior Authorization Specialist - Medical Billing Liaison

SOUTHEASTERN RETINA ASSOCIATES PC; Knoxville (TN); On-site; USD 38,000 - 52,000; Full time

Job summary

SOUTHEASTERN RETINA ASSOCIATES PC in Knoxville, TN is seeking a Medication Authorization Coordinator to request authorizations from health plans, verify prior-authorization requirements, and assist with billing questions to ensure proper payment for procedures.

The role requires a high school diploma and at least two years of medical billing experience with ICD10/CPT knowledge; strong organization and communication skills, and the ability to liaison with payors, patients, and staff.

Qualifications

• Two years of medical-related experience with knowledge of diagnosis codes (ICD10), procedure codes (CPT), injectable drug code (HCPCS).
• Healthcare insurance knowledge and billing requirements knowledge and experience is necessary

Responsibilities

• Check physicians’ daily schedules for use of specialty drugs before scheduled appointment
• Check for prior authorization requirements for any procedures or specialty drugs
• Set up patients for Free Drug through respective Drug Company
• Assist staff members and physicians with billing questions
• Scan and import correspondence in Practice Management system
• Provide documentation for each patient regarding pre-authorizations, pre-certifications, eligibility, and benefits that have been completed
• Answer incoming calls from clinic staff to provide direction on treatment options
• Appeal any denied drug authorizations
• Act as liaison person between all payors, patients, physicians, and staff to resolve any outstanding claims
• Maintains current information regarding all payors

Skills

Organizational skills

Communication skills

Convey ideas clearly

Follow-through

Team collaboration

Education

High School Diploma

Job description

SOUTHEASTERN RETINA ASSOCIATES PC in Knoxville, TN is seeking a Medication Authorization Coordinator to request authorizations from health plans, verify prior-authorization requirements, and assist with billing questions to ensure proper payment for procedures.

The role requires a high school diploma and at least two years of medical billing experience with ICD10/CPT knowledge; strong organization and communication skills, and the ability to liaison with payors, patients, and staff.