Sycamore Medical Management on behalf of The Plastic Surgery Center is the largest private Plastic and Reconstructive surgery practice in NJ and is distinguished by the outstanding training and backgrounds of our top plastic surgeons. Between them, our team of doctors has more than 100 years of combined experience performing cosmetic surgery of the face, skin, and body. In addition to common cosmetic plastic surgery we offer advanced reconstructive procedures and have developed a number of innovative surgical techniques offered at few other facilities in the world for complex conditions, diseases and traumatic injuries.
Sycamore Medical Management is seeking an Prior Authorization Specialist.
Responsibilities:
* Obtain and/or verify patient insurance benefit coverage by use of insurance websites, such as Navinet, or by contacting the insurance carriers prior to patient appointment. Clearly document details of the verification for service reference.
* Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
* Request, follow up and secure prior-authorizations prior to services being performed.
* Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
* Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
* Communicate any insurance changes or trends among team.
* Maintains a level of productivity suitable for the department.
* Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
* Review accuracy and completeness of information requested and ensure that all supporting documents are present.
* Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
* Prioritize the incoming authorizations by level of urgency to the patient
* Communicate with medical providers and other staff members about any patient concerns and/or issues related to verification.
* Knowledge of medical terminology.
* Ability to build and maintain strong relationships with insurance representatives.
* Ability to work effectively with physicians and other medical staff.
* Maintain patient and company confidentiality.
Requirements:
* High School Diploma or equivalent
* Two years of experience in a health care environment
* Knowledge of Out of Network providers highly preferred
* Experience with insurance authorizations preferred
* Excellent verbal and written communication skills.
* Excellent organizational and business office skills.
* Goal and detail-oriented and able to perform successfully in a fast-paced environment
Compensation:
* Competitive Salary commensurate upon experience
* Medical, Dental, Vision, Life, AFLAC and Long-Term Disability insurance
* 401k and Profit sharing
* Paid Time Off
* Mileage Reimbursement
* Contribution to Health Benefits
* Company Discounts on Products & Services
Schedule:
* Monday to Friday
Education:
* High school or equivalent (Preferred)
Experience:
* Customer Service: 1 year (Preferred)
* Prior Authorization: 1 year (Required)
Work Location: In person
IND2
Job Type: Full-time
Benefits:
* 401(k)
* Dental insurance
* Employee discount
* Health insurance
* Health savings account
* Life insurance
* Paid time off
* Vision insurance
Weekly day range:
* Monday to Friday
Application Question(s):
* What are your salary requirements? (provide numeric answer only)
Experience:
* prior authorization/insurance verification: 2 years (Required)
* Medical office: 2 years (Required)
Language:
* Spanish (Required)
Work Location: In person