Prior Authorization Representative

Pinellas Park, FL

Description

Looking for a change?

We are adding to our Revenue Cycle Management team in St. Petersburg, FL!

At Clear Sight Partners, we are building the region’s premier destination for comprehensive vision care. We are a team of over 130 optometrists, ophthalmologists, surgeons, opticians, and eye care professionals serving more than 100,000 patients across 15 different locations in the Greater Tampa Bay area. From routine eye exams and optical retail, to medical optometry, ophthalmology, and surgical procedures, our patients experience end-to-end personalized care and service.

Requirements

The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribes and triages patient calls to physicians, and coordinates patient appointments/orders.

Essential Functions and Responsibilities

  • Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
  • Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
  • Request, follow up and secure prior authorizations prior to services being performed.
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
  • Communicate any insurance changes or trends among team.
  • Maintains a level of productivity suitable for the department.
  • Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
  • Other duties as assigned.
  • Qualifications

    • Minimum of 2 years of performing pre-authorization in a clinic or similar setting
  • Medicaid, Medicare, and other third-party payor reimbursement guidelines and requirements
  • Experience working with confidential medical information
  • Experience in computer programs such as EMRs, Word, Excel
  • Skills and Abilities

    • Ability to navigate various websites and carrier portals
  • Highly organized with developed time management skills
  • Excellent customer service and telephone etiquette
  • Excellent verbal and written communication skills
  • Strong research and problem-solving skills; attentive to details
  • Ability to operate a computer and general office machines
  • Must be self-directed, able to work independently, as well as work in a team-oriented and fast paced environment
  • Ability to clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
  • Benefits

    • Paid Time Off and 8 Paid Holidays
  • Medical, Dental, Vision insurance benefits
  • 401k and 401k Match