Job Title

This is a non-exempt on-site role, located at our New Providence CBO location. Compensation Range: $21.38-$44.40/hr (Dependent on Experience) The Revenue Cycle Specialist (Prior-Authorization) reports to the Senior Revenue Cycle Manager and is responsible for a variety of duties including, but not limited to, reviewing patient information, workflow reporting, prior-authorization submission, and troubleshooting with all insurance carriers. The Revenue Cycle Specialist is responsible for completing prior-authorizations with accuracy and timeliness. Role and Responsibilities: * Identifies all appointments and procedures that require prior-authorization by monitoring system reports * Reviews patient diagnoses and medical notes/laboratory reports required for prior-authorizations submissions * Accountable for knowledge of updated drug and procedure prior-authorization requirements, relating to all commercial insurance carriers * Communicates with Insurance carriers by phone for cases of urgency, down systems, research/clarifications or troubleshooting * Independently maintains and updates multiple reports on all upcoming patient appointments and prior-authorizations * Maintains patient confidentiality * Utilizes insurance portals to submit prior-authorizations * Troubleshoots prior-authorization cases for insurances * Manages a high-volume demand for prior-authorizations with accuracy * Attends and participates in NJ Retina / or payer meetings/seminars as needed * Maintains open, positive cordial, team-oriented lines of communications with managers and staff members * Contributes to the Business office team thought, positive attitude, respectful interaction, innovative ideas and efficiently * Other duties as assigned Essential Qualifications: Education: High School Diploma or equivalent; Bachelor's degree preferred. Experience: 1+ years' experience in an administrative role; medical billing experience within Ophthalmology preferred but not required. Knowledge/Skills/Experience * Working knowledge of prior-authorization process * Experience with Medicare, insurances, claims, appeals * Knowledge of CPT, ICD-9 and/or ICD-10 codes a plus * Proven customer service skills * Able to work in a high volume/fast-paced environment * Excellent written and verbal communication skills * Outstanding attention to detail and excellent time management skills * Outstanding typing and computer skills with billing software, Microsoft Word and Microsoft Excel * Ability to work with sensitive and confidential information