Prior Authorization Specialist

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.

Pay: $20+ per hour

Key Benefits for Full-Time Employees:

• Competitive pay based on experience, minimum $20

• 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

• 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

If you're eager to contribute to a world-class healthcare team, apply today. We look forward to welcoming dedicated professionals to contribute to the growth of our practice.

Equal Opportunity/Drug-Free Workplace:

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

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