Pri-Auth Specialist Ophthalmology | Medications | Radiology & Infusion

Roles and Responsibilities

• Verify patient eligibility, benefits, and insurance coverage for ophthalmic procedures.
  
• Obtain prior authorizations from payers for scheduled surgeries and treatments.
  
• Coordinate with healthcare providers to resolve any discrepancies or issues related to medication orders, radiology results, or infusions.
  
• Ensure accurate documentation of all interactions with patients, physicians, and insurance companies.
  
• Maintain confidentiality and adhere to HIPAA guidelines throughout the process.
  

Desired Candidate Profile

• 1-5 years of experience in Prior Authorization (PA), Eligibility Verification (EV), Insurance Verification (IV) or RCM (Revenue Cycle Management).
  
• Strong understanding of Ophthalmology specialty codes (e.g., ICD-10-CM/PCS) and Medicare/Medicaid regulations.
  
• Proficiency in using electronic medical records systems (EMRs) such as Epic Systems or similar platforms.
• Expertise in specialty Ophthalmology | Medications | Radiology & Infusion