Job Description
Job Description
Title: Authorization Specialist
Department: Finance, Revenue Cycle Management
Reports to: Revenue Cycle Management Lead
FLSA: Non-Exempt (Hourly)
Job Type: Full-time, 40 hours per week. On-site.
About Us:
At Retina Specialty Institute and Southern Eye Group we are dedicated to preserving and improving the gift of sight. As growing leaders in the field of ophthalmology, we utilize cutting-edge technology and the latest advancements in healthcare to provide exceptional care to our patients. Our commitment to excellence drives us to prioritize patient care above all else, ensuring that each patient receives the highest standard of treatment. We believe that by saving sight, we are not only preserving vision but also enhancing lives. Join our team and be a part of our mission to make a difference in the lives of our patients every day.
General Purpose of Job/Summary:
We are seeking a detail-oriented and proactive Authorization Specialist to join our Revenue Cycle Management team. The Authorization Specialist is responsible for securing prior authorizations for medical services and medications, ensuring timely and accurate processing to support clinical care and reimbursement. This role is essential to helping our team deliver seamless patient experiences while maintaining the financial integrity of our services. Candidates with strong organizational skills, keen attention to detail, and a passion for healthcare administration are encouraged to apply.
Essential Duties and Responsibilities:
- Request, track, and secure pre-authorizations from insurance carriers within the allotted time for services.
- Scrub claims for errors prior to billing to minimize delays and denials.
- Clearly document all communications with insurance carriers, referring physicians, and internal team members using standardized documentation practices.
- Review patient medical histories and verify insurance coverage and benefits to ensure approval for services.
- Input new patient information and update existing records in our electronic systems.
- Monitor and manage authorization schedules, including auditing AM/PM reports to identify services requiring approval.
- Place detailed notes in the Electronic Medical Record (EMR) to assist during the “financial time-out” process.
- Proactively work the schedule, at least two weeks ahead, to secure necessary authorizations.
- Conduct diligent follow-up to obtain retrospective or urgent authorizations for missed services.
- Coordinate with the billing department to address gaps and resolve denials.
- Respond promptly to inquiries from front desk staff and technicians regarding authorization requirements.
- Adhere to HIPAA, billing regulations, and company policies in all aspects of the job.
- Work closely with other departments to ensure smooth billing operations.
Qualifications:
- High school diploma or equivalent.
- Previous experience in a medical clinic environment and familiarity with medical terminology.
- Prior experience with healthcare insurance eligibility and obtaining prior authorizations.
- Experience with electronic medical records (EMR) and electronic scheduling system.
- Preferred: Associate’s degree or higher; billing and collections experience in a medical office; working knowledge of healthcare insurance; certifications related to medical billing or coding.
Required Skills & Abilities:
- Maintains a composed demeanor, pleasant attitude, and polished, professional appearance.
- Demonstrated proficiency with technology; familiarity with relevant software applications, electronic medical records (EMR) systems, and electronic scheduling systems.
- Will observe all company confidentiality requirements and HIPAA regulations to protect patient privacy and maintain HIPAA compliance.
- Ability to work independently and in a team.
- Outstanding written and oral communication skills; handles company business with the utmost professionalism, discretion, and tact.
- Adept at managing multiple urgent tasks simultaneously in high-pressure situations without compromising accuracy.
- Strong organizational and follow-up skills.
- Dependable, punctual, and reliable with an excellent attendance record.
Offered Benefits:
- Competitive salary commensurate with experience.
- Health, dental, and vision insurance.
- Life insurance, disability coverage, and ancillary benefits offered.
- 401k eligibility with company match.
- Paid time off and holidays.
- Opportunities for professional development and certification.
- Friendly, upbeat, and supportive work environment.
Equal Opportunity Employer:
Retina Specialty Institute and Southern Eye Group are equal opportunity employers. We value diversity and are committed to creating an inclusive environment for all employees. It is the policy of our companies not to discriminate on the basis of age, color, sex, disability, national origin, race, religion, gender identity, sexual orientation, veteran status or any other characteristic protected by law.
Physical Requirements and Work Environment:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions to the extent the Company may do so without undue burden.
This role involves sitting for extended periods at a desk and working on a computer. Occasional standing, walking, stooping, kneeling, crouching, reaching, and lifting up to 15 pounds may be required. Specific vision abilities needed include close, distance, peripheral vision, and focus adjustment.
The work takes place in a climate-controlled office with moderate noise levels.
Other Duties:
This job description provides an overview of key duties but is not all-inclusive. Responsibilities and tasks may evolve over time, and adjustments may be made as needed, with or without prior notice.