Prior Authorization Specialist

Utilizing billing, clinical resources, and customer service skills to effectively and efficiently triage for prior authorization requirements as needed for coverage. Performs day to day Insurance Verification and Prior Authorization activities to support the Revenue Cycle and to ensure reimbursement for services in a timely and accurate manner. The identification of Duties and Responsibilities does not display an exhaustive list of all duties that may be assigned to this position, nor does it restrict the related work that may be assigned to this position.

Schedule: Must be able to work on-site M-F, 8:00-4:30pm.

• Review insurance requirements to determine if prior authorization is required.
• Utilizes resources to identify any testing that may require prior authorization.
• Verifies insurance eligibility.
• Calls patients to discuss copayments and deductibles.
• Review chart documentation to ensure patients meet payers medical necessity policy guidelines.
• Review requisition to determine billing information, including insurance carrier and complete/submit accurate documents as required.
• Coordinate with client to obtain needed medical documentation.
• Ability to accurately complete the necessary paperwork to submit prior authorization request to insurance via phone, website, software, or fax.
• Timely follow-up with insurance carriers on pending prior authorization requests.
• Timely notification of appropriate RCM department of prior authorization status.
• Maintains current knowledge of payer policies and requirements and acts as a resource to team members and patients.
• Maintain HIPAA Compliance.

• Ability to review patient chart to ensure completeness and accuracy of information.
• To be well-organized with a strong attention to detail is essential.
• Ability to work efficiently and effectively under tight deadlines and high work volume.
• Advance knowledge of medical billing and coding.
• Ability to assist consistently with patient and physician request and act as a resource regarding insurance and authorization requirements.
• Excellent problem-solving skills.

• Possess at least one year of experience in a clinical setting.
• Knowledge of medical billing and coding.
• Must be able to lift up to 50 pounds.
• High school graduate or equivalent.
• Ability to work as a team member as well as independently.
• Strong interpersonal and communication skills.

• Competitive wages.
• Robust benefit package including medical, dental, life and disability (short- and long-term) insurance.
• Generous paid time off (PTO) program.
• Seven (7) company paid holidays.
• 401(k) retirement plan with company match.
• Uniform reimbursement.
• An organization focused on People, Passion, Purpose and Progress.
• Inspirational culture.

Midwest Vision Partners was founded in 2019 to build a premier eye care platform in partnership with Alpine Investors, a San Francisco-based private equity firm. Alpine is a strong supporter of MVP, given their People First™ philosophy, unparalleled track record, significant financial resources, and a commitment to building a platform that includes physician leadership at the highest levels. Headquartered in Chicago, our mission is to provide world-class support to ophthalmologists and optometrists, enabling them to focus on improving patients' vision to help people live their best lives.

Today, MVP's network consists of 16 practices, 125 physicians, and roughly 1500 employees providing medical and surgical eyecare services at over 60 locations throughout the Midwest. We strive to be the premier provider of eyecare in the Midwest through a culture of collaboration and excellence.

Job Posted by Applicant Pro