Company Overview
At DOCS Dermatology Group, we are not just one of the largest dermatology practices in the nation; we are a dedicated community passionate about skin health! With more than 200 providers across 20 practice brands and 100+ locations in 10 states, we’ve been transforming the lives of our patients for more than 40 years. Our mission is clear: to prioritize our patients with outstanding medical, surgical, and cosmetic dermatology services, all delivered in a friendly, convenient, and compassionate environment.
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) system
Benefits
- Our benefits package includes medical, dental, and vision insurance, 401k matching, company paid life insurance, employee assistance program, and paid time off.
Minimum 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 Demands
- While 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
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