<p>This position is eligible for Mid Atlantic Retina's $1,000 Hiring Incentive! The hired candidate will receive $500 after successful completion of 90 days of employment and $500 after successful completion of 1 year of employment! Available to new hires only- not available to agency hires, internal transfers, or re-hires.</p> <p>Job Type: Full Time</p> <p>Benefits: Medical, Dental, Vision, Paid Sick Time, Paid Vacation Time, 7 Paid Holidays and more</p> <p>Job Description</p> <p>This position is responsible for reviewing medical records and medical policies to obtain all necessary pre-authorizations and pre-determinations for patients to receive treatment with a medical drug injection.</p> <p>Essential Functions</p> <ul> <li>Retrieves and reviews patient medical record from MDI to facilitate approval of pre-authorization or pre-determination submission. </li><li>Submits pre-authorization or pre-determination to payer through their website or by calling them directly. </li><li>Consistently follows up with payer to ensure all required documentation has been received. Researches and resolves any issues or errors. </li><li>Navigates payer website to retrieve pre-authorization or pre-determination for injection patient. </li><li>Monitors all assigned schedules in NextGen for add-ons and changes. Processes updates as needed. </li><li>Recognizes, interprets, and evaluates inconsistencies, discrepancies, and inaccuracies in patient accounts along with system files, and initiates appropriate corrective methods. </li><li>Maintain up to date billing knowledge of insurance carriers and their clinical policies pertaining to step therapy, authorizations, and covered diagnosis. </li><li>Act as customer service representative in person or by telephone for any patient's questions about his/her account. </li><li>Regular and predictable on-site attendance. </li><li>Works overtime as needed. </li><li>Travels to other MAR locations as needed. </li><li>Performs other duties as assigned. </li></ul> <p>Competencies</p> <ul> <li>Problem Solving / Analysis - Creative problem solving within defined acceptable parameters. Identifies and resolves problems in a timely fashion. </li><li>Customer Service- Superior listening skills, professional demeanor, and appropriate firmness. </li><li>Conflict Resolution- Responds promptly to customer needs. Ability to handle difficult patient interactions relative to sensitive billing issues. </li><li>Detail Oriented - Ensure proper procedures, protocols and processes are complied with consistently. </li><li>Strong Interpersonal Skills- Works effectively with patients, employees, and physicians. </li><li>Creative problem solving within defined acceptable parameters. </li><li>Time Management- maintains high volume productivity level for essential functions. </li><li>Ethical Conduct - Maintains confidentiality. </li></ul> <p>Required Education and Experience</p> <ul> <li>Benefit authorization experience preferred. </li><li>Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals. </li><li>Experience with CPT codes and ICD-10. Microsoft Office Suite required. </li></ul>