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Authorization Specialist

US EyeHealthcare & Nursing
Hiring from
Probably Worldwide
Work type
Remote
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Authorization Specialist
Location: Remote in AL, FL, GA, IL, IN, MI, MO, NC, OH, PA, SC, TN, TX, VA
About US Eye: US Eye is a physician-led, patient-centric network of eye care practices committed to providing exceptional patient service through premium technology and unrivaled provider expertise. We are one of the nation’s leading multi-specialty physician groups providing patients with care in ophthalmology, optometry, dermatology, and facial surgery. With 50 clinics and five surgery centers, led by 95 providers and more than 1,000 team members system-wide, we deliver world-class care to patients throughout Florida, the Carolinas, and Virginia.
JOB SUMMARY:
We are seeking a detail-oriented and organized Authorization Specialist to join our team remotely. In this role, you will oversee verification and authorization processes to ensure accuracy, compliance, and timely approvals across departments.
PRIMARY DUTIES:
  • Authorization & PCP Referrals
    • Obtain authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed, staying a minimum of seven days ahead of scheduled service, and ensuring that authorization, referral, or pre-determination is obtained for add on appointments in advance or on the same day of service.
    • Obtain vision plan authorizations.
    • Obtain PCP referrals for HMO’s and provide feedback to supervisors on any particularly difficult or time-consuming PCP offices.
    • Obtain prior authorization or pre-determination as needed for clinic and facility services.
    • Obtain prior authorization for procedures as required by insurance plans.
    • Review MDI Pending notifications for imaging orders and obtaining prior authorization for those which need approval.
    • Coordinates patients’ assistance applications for specific procedures when applicable, to include financing options for patients.
    • Document authorization, referral, pre-determination activities in NextGen.
Secondary Duties:
  • Eligibility verification
    • Verify eligibility as active staying a minimum of a week ahead of scheduled service.
    • Verify eligibility as active for add-on appointments, staying ahead of schedule and verifying eligibility the same day for services scheduled and performed on the same day.
    • Use NextGen to identify and correct inactive or incorrectly registered policies and address.
    • Utilize payer websites for further verification when needed.
    • Contact patients to update / obtain correct information when needed.
    • Validate that the correct plan was chosen per the insurance guide and provide feedback to supervisor for feedback to upstream areas.
    • Confirm network participation and advise patient of our provider’s network participation when needed.
    • Forward new plans to supervisor for payer file updates.
    • Document verification activities in NextGen to support productivity and quality tracking.
    • Ensure NextGen system is updated.
OTHER DUTIES AND RESPONSIBILITIES:
During non-peak times, providing additional RCM Support within other departments (i.e., patient assistance – enrollments, shipments, and replacement drugs), A/R Support (Claim status for unresponded to claims, review and outreach to patients with large outstanding balances and accounts in pre-list status, targeted denial management).
COMPETENCIES:
  • Proven experience in verification, authorization, or related administrative roles.
  • Strong attention to detail and organizational skills.
  • Excellent written and verbal communication with a compassionate, patient-centered approach.
  • Ability to work independently in a remote environment and manage multiple priorities.
  • Proficiency with EHR and billing platforms (e.g., NextGen and Intellichart Pro, etc).
  • Exceptional attention to detail, organization, and multitasking ability in a fast-paced environment.
REQUIRED EDUCATION AND EXPERIENCE:
  • A high school graduate or equivalent
  • Customer service and healthcare experience
  • Proficient in computer and typing
  • Knowledge of Microsoft Office products (Word, Excel)
  • Excellent customer service skills in phone, person or via email
  • Ability to manage multiple, ongoing tasks while maintaining professional composure.
  • Have an understanding of insurance and medical terminology.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice
PHYSICAL DEMANDS:
  • Prolonged periods of sitting at a desk and working on a computer.
  • The noise level in the work environment is usually moderate.
  • Moderate lifting 10-50lbs
  • Hybrid role
  • Ability to travel between locations as necessary
POSITION TYPE AND EXPECTED HOURS OF WORK:
This is a full-time position. Days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M. with occasional overtime.
Benefits:
401(K) Company Match
Medical and Dental Insurance
Vision Benefits
Paid Parental Leave
Flexible Spending Accounts
Disability Insurance
Life Insurance
Paid Time Off
US Eye is a physician-led, patient-centric network of eye care practices committed to providing exceptional patient service through premium technology and unrivaled provider expertise. We are one of the nation’s leading multi-specialty physician groups, providing care in ophthalmology, optometry, dermatology, and facial surgery. With 50 clinics and 5 surgery centers, led by 95 providers and more than 1,000 team members system-wide, we deliver world-class care to patients throughout Florida, the Carolina's, and Virginia.
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws

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