Insurance Authorization Specialist

Vitreoretinal Consultants of NY is the premier retinal care destination for patients across Long Island, Queens, NYC, and beyond. Founded in 1981, our team of nationally-recognized retina specialists and surgeons have established themselves as distinguished physicians, compassionate providers, and key thought leaders in the retina care community. We are committed to providing a compassionate and ethical environment that focuses on patient-centered care. From diagnostics to clinical trials, we bring clarity, transparency, and humanity to all aspects of what we do. We have a very high level of patient satisfaction and are proud of our reputation, online and in the medical community. https://www.vrcny.com/why-vrc

Job Purpose:

To verify eligibility of insurance, to confirm plan coverage for various office visits, medical procedures and treatments of patients to ensure timely payment of such visits. Advises physicians of any insurance/managed care constraints. Assists patients in obtaining funding through Chronic Disease Fund or Genentech Access to Care Foundation. Obtains or advises patients the need for proper referrals.

Duties:

• Verifies insurance/managed care plans for eligibility for all of the insurance plans listed in the patient account.

• Uses Athena to confirm eligibility and/or contacts the payer directly and documents the outcome in the patient account.

• Contacts patients directly when insurance has terminated or shows ineligible in attempts to obtain new information prior to office visits.

• Will pre-certify all patient testing, procedures and injections by confirming their insurance/managed care plan eligibility in addition to confirming whether prior authorization for visits and treatments are necessary.

• Advises both physician and patient of insurance findings and benefit investigations, discusses the possibility of supplemental funding through Chronic Disease Fund and Access to Care Foundation

• Will assist patients with the proper forms necessary for CDF and GATCF and confirm when funding is in place. Provides the proper clinical documentation to the foundations as needed.

• Obtains and/or advises patients of the need for referrals as indicated on their insurance plan, i.e. BCBS, Aetna, Oxford, HIP and/or HCP. Obtains all Healthcare Partners referrals for existing patients providing all clinical documents, as necessary.

• Advises staff of any insurance plan updates.

• Orders specialty pharmacy drugs for patients and maintains an accounting through the PODIS system.

• Checks patient balances on upcoming appointments for accuracy and presents to the front desk to collect.

Skills/qualifications:

• Knowledge of insurance company/managed care organization constraints related to the retinal practice’s office procedures, visits, testing and drug therapy.

• Computer, telephone and all business equipment skills needed.

• Good organizational skills and ability to handle multiple tasks.

• Ability to prioritize work related duties.