Authorization Specialist (On-Site)

About Bay Area Retina Associates

Bay Area Retina Associates (BARA) is an established Ophthalmology practice with over 35 years in the industry, renowned as a premier group of highly skilled ophthalmologists specializing in state-of-the-art retinal treatments. With nine conveniently located facilities across the Bay Area, our unwavering commitment is to provide high-quality care to our patients.

Job Summary

The Authorization Specialist will ensure accurate, prompt, and necessary authorization is obtained for patients. This position involves working closely with staff, insurance carriers, patients, as well as the doctors who treat them. Supporting day- to-day revenue cycle operations and goals as well as working with Authorization Lead to accomplish set goals for the department to execute daily tasks.

Job Duties

• Obtain authorization for patient services in accordance with practice/provider schedules
• Maintains appropriate authorization logs, records, and reports as established by Revenue Cycle Department (as appropriate).
• Inputs all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking
• Notifies required parties within the appropriate timeframe for routine and urgent requests for services
• Communicates information with physicians and enters data into an established database
• Monitor and resolve issues with the Authorization and Eligibility process coordinating with Lead as necessary
• Maintain knowledge and understanding of Eligibility and Authorization. Working closely with AR Denial Management to resolve claims issues
• Documents all procedures scheduled accurately and according to department protocols
• Ensures accurate coordination of authorizations prior to scheduled visits
• Verifies patient’s responsibility and benefits with specialty pharmacy
• Communicates with Operations pertaining to authorization concerns/challenges for patients
• Identify patients’ needs, clarify information, research issues and work with RCM leaders to resolve
• Build sustainable relationships and engage patients by going the extra mile
• Notifies required parties within the appropriate timeframe for routine and urgent requests for services
• Possess strong computer skills and the ability to maneuver multiple resources
• Meet department/team qualitative and quantitative targets
• Comply with all HIPAA rules and regulations; obtain 2 patient identifiers with each interaction
• Other duties as assigned

• High School Diploma or GED
• Certification or Diploma in Business Administration in Healthcare or related

Experience:

• 1 Year of experience with EMR/EHR systems
• 1 Year of experience in a Medical Office / Hospital / Healthcare Setting
• 1 Year of experience in Authorizations/Insurance Carrier

Other requirements:

• Making Decisions and Solving Problems- Reviewing information and evaluating results to choose the best solution and solve problems.
• Establishing and Maintaining Interpersonal Relationships- Developing constructive and cooperative working relationships with others and maintaining them over time.
• Evaluating Information to Determine Compliance with Standards- Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• Getting Information- Coordinating, receiving, and otherwise obtaining information from all relevant sources.
• Monitor and execute work on assigned surgeries
• Communicate trends and root issues through proper lines of reporting
• Meet productivity and Key Performance Indicator standards
• Some travel may be required

Benefits

• Medical, Dental, Vision and other voluntary benefits
• 401k Plan with employer contribution and profit sharing
• Rich PTO Plan