DOCS Dermatology
Prior Authorization Specialist
DOCS Dermatology, Mason, Ohio, United States, 45040
Company Overview Dermatologists of Central States (DOCS) is one of the largest and most established dermatology practices in the nation. With more than 186 providers within 80+ locations in 7 states, we have been serving patients for over 40 years. At DOCS, we strive to put the patient first with an emphasis on medical, surgical, and cosmetic dermatology. We provide easy access to high quality dermatologic care in an environment that is consistently friendly, convenient, courteous, and caring.
Summary The Prior Authorization Specialist plays a vital role in ensuring efficiency and accuracy of our billing process. This role also directly impacts our patients, resulting in a positive patient experience.
Job Responsibilities
Streamline and secure pre-certification, medical authorization, and referral processes, ensuring compliance with insurance requirements.Coordinate with insurance entities, review boards/organizations, and clinical contacts for effective communication and benefit determination.Establish positive rapport with employees, patients, physicians, and vendors utilizing written and verbal communication methods.Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients.Ensure timely and accurate insurance authorizations and conduct medical benefits investigations.Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet.Initiate patient education on available assistance programs.Document information, responses, and status updates/changes in Electronic Medical Record (EMR) systemMinimum Qualifications
High school diploma or equivalent.1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice.Knowledge of Medicare/Medicaid and major insurance carrier's guidelines.Working knowledge of ICD-9-10 medical coding and billing and medical terminology.Physical DemandsWhile performing the duties of this job, the employee is required to:Frequently sit, stand, walk, talk, hear, and use devices including but not limited to computers, phones, and iPads.Regularly use close vision and ability to adjust focus.Occasionally stoop, bend, reach above shoulders, push/pull doors and drawers, and lift up to 25 pounds.Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status
Summary The Prior Authorization Specialist plays a vital role in ensuring efficiency and accuracy of our billing process. This role also directly impacts our patients, resulting in a positive patient experience.
Job Responsibilities
Streamline and secure pre-certification, medical authorization, and referral processes, ensuring compliance with insurance requirements.Coordinate with insurance entities, review boards/organizations, and clinical contacts for effective communication and benefit determination.Establish positive rapport with employees, patients, physicians, and vendors utilizing written and verbal communication methods.Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients.Ensure timely and accurate insurance authorizations and conduct medical benefits investigations.Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet.Initiate patient education on available assistance programs.Document information, responses, and status updates/changes in Electronic Medical Record (EMR) systemMinimum Qualifications
High school diploma or equivalent.1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice.Knowledge of Medicare/Medicaid and major insurance carrier's guidelines.Working knowledge of ICD-9-10 medical coding and billing and medical terminology.Physical DemandsWhile performing the duties of this job, the employee is required to:Frequently sit, stand, walk, talk, hear, and use devices including but not limited to computers, phones, and iPads.Regularly use close vision and ability to adjust focus.Occasionally stoop, bend, reach above shoulders, push/pull doors and drawers, and lift up to 25 pounds.Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status