What are the responsibilities and job description for the Medical Biller/Prior Authorization Specialist position at Greater Chicago Specialty Physicians?
We are a busy Rheumatology practice looking for an experienced full-time Medical Biller with Prior Authorization experience to join our team. The position will requires knowledge in all aspects of billing, mainly focusing on medical benefits verification and prior authorization for our infusion therapy services. The role requires a high level of independent judgment and knowledge of industry best practices.
Responsibilities and Qualifications include:
- Charge review, claim and lab submission, reconciliations, payment posting, and working appeals of denials.
- Obtain and verify complete insurance eligibility, including prior authorizations, copay assistance, and coordination of benefits.
- Research and follow up on prior authorization denials.
- Resolve claim rejections for eligibility, coverage, and other issues.
- Serve as the point of contact with drug reps for contracted payers. MUST remain up to date on the contract, network, and fee schedule information.
- Work closely with physicians and the clinical team to collect additional clinical information on physician orders during the verification process.
- Performs critical evaluation of pending patient cases and keeps management apprised of any trends or issues.
- Handle benefits verification and prior authorizations for infusion therapy services.
- Perform basic mathematical calculations.
- Maintains up to date professional knowledge of Medicare and Commercial insurance industry requirements.
- Excellent organizational, interpersonal, communication, and customer service skills.
- Experience working with Microsoft Office Suite applications.
- Knowledge and experience with EMR systems, eClinicalWorks preferred.
- Ensure pre-certifications/prior authorizations are obtained for scheduled office infusions.
- Maintains current knowledge of insurance requirements, benefit provisions and pre-certification.
- Contacts patients to provide updates on precertification status.
- Consistently meets quality and productivity requirements.
- Previous experience with medical insurance benefit verification, and prior authorization preferred.