What are the responsibilities and job description for the Prior Authorization Specialist position at DOCS Dermatology Group?
Company Overview
At Dermatologists of Central States (DOCS), 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
At Dermatologists of Central States (DOCS), 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
- Our benefits package includes medical, dental, and vision insurance, 401k matching, company paid life insurance, employee assistance program, and paid time off.
- 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.
