Prior Authorization and Referral Specialist

Authorization and Referral Specialist
We are Family Eye Physicians and we’re looking for an Authorization and Referral Specialist to join our Billing Team. This is a full-time position, onsite, in Oak Brook Terrace, IL location. In this role, you will request and complete authorizations and referrals for our Ophthalmology practice. You will ensure that we have the prior authorization and/or referral we need to move forward, in advance of our patient’s appointment or procedure.

Key Responsibilities:

• Review appointment schedules and process prior authorization requests for medical services
• Verify patient insurance coverage and eligibility for requested services.
• Monitor schedules for potential issues prior to appointment date
• Interact with insurance companies to submit authorization requests and follow up on pending approvals.
• Contact referring physicians for additional information as needed
• Maintain accurate records of authorization requests and outcomes in the electronic health record (EHR) system.
• Assist patients, internal staff and physicians in understanding authorization requirements and processes.
• Collaborate with the billing team to resolve authorization-related issues and ensure continuity of care.
• Provide training and support to new staff on prior authorization procedures.
• Prepare reports and analyze data related to authorization trends and outcomes.

• High school diploma or equivalent; associate’s degree in a relevant field preferred.
• Previous experience (1-2 years) in a prior authorization or medical billing role is highly desirable.

• Strong knowledge of medical terminology, coding, and insurance regulations.
• Excellent communication and interpersonal skills.
• Detail-oriented with strong organizational and time-management abilities.
• Proficient in using EHR systems and Microsoft Office Suite. Knowledge of Nextech / Practice Plus preferred
• Proficient in utilizing insurance portals including:
  Availity, UHC, Humana, Cigna
• Ability to work independently and as part of a team in a fast-paced environment.