Prior Authorization Specialist- Ophthalmology Practice

We are seeking a versatile Medical Biller & Administrative Specialist to support our busy Ophthalmology practice. This role is unique in that it combines the technical precision of the Revenue Cycle (AR, Claims, Denials) with the patient-centric flow of Front Office Administration.

The ideal candidate is a "Hybrid VA" who understands the nuances of vision-related medical coding and is equally comfortable navigating AthenaHealth to troubleshoot a denied claim or provide a warm experience for a patient on the phone.

Key Responsibilities

1. Revenue Cycle Management (RCM)

• Claims & Denials: Manage the full lifecycle of insurance claims, including scrubbing, submission, and aggressive follow-up on rejected or denied claims.
• A/R Management: Review Aging Reports to identify outstanding balances and execute recovery strategies.
• Appeals: Draft and submit clinical appeals for denied Ophthalmic procedures (e.g., injections, surgeries, or diagnostic imaging).
• Payment Posting: Accurately post insurance payments and patient co-pays within AthenaHealth.

2. Front Office Administration

• Patient Scheduling: Manage a high-volume surgical and routine exam calendar, ensuring appointments are optimized for provider flow.
• Inbound/Outbound Calls: Serve as a primary point of contact for patient inquiries, scheduling requests, and general practice questions.
• Insurance Verification: Perform real-time eligibility checks and explain out-of-pocket costs or vision vs. medical insurance differences to patients.
• Chart Readiness: Ensure all patient charts are prepped with necessary authorizations and referrals prior to the date of service.

Requirements

Required Qualifications

• Specialty Experience: Minimum of 2 years in Ophthalmology. You must understand terms like IOLs, Macular Degeneration, Glaucoma, and the difference between routine vision and medical eye care.
• Software Mastery:AthenaHealth proficiency is mandatory. You should be comfortable navigating the claim center, scheduling modules, and patient buckets.
• Billing Knowledge: Deep understanding of ICD-10 and CPT coding specific to eye care.
• Communication: Exceptional English verbal and written skills. You must be able to explain complex billing issues to patients with empathy and clarity.

Benefits

• Full-time
• Competitive compensation based on experience

• Opportunity to work with a growing ophthalmology practice
• Training and support for continuous professional development