Prior Authorization Specialist

About the role

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

Responsibilities

• 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 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

Pay

$18–$22 per hour

Benefits

• Competitive pay based on experience, minimum $18–$22/hr 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

Schedule

Monday–Friday, 8:00 am–4:30 pm, Hybrid (2 days in office, 3 days remote after full in-office training)