Authorization Specialist at American Vision Partners in Salinas, CA

Company Intro

At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers.At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees!

Overview

This position verifies insurance coverage, benefits and obtains prior authorization for services.

Responsibilities

MAIN:

• Contacts insurance plans to determine eligibility and obtain coverage and benefit information.

• Obtains prior authorization for services.

• Processes requests for prior authorization for surgery and/or procedure injections

• Identifies and resolves problems with participant eligibility/insurance coverage

• Accurately calculates patient responsibility amounts based on benefit information and payer allowable.

• Documents findings thoroughly and accurately.

• Prioritizes work to maximize turn-around time.

• Meets or exceeds productivity standards in the completion of daily assignments and accurate production.

• Maintain an error rate in accordance with departmental policy.

• Makes changes to demographic information as necessary in order to produce a clean patient statement.

• Answer and respond to external and internal phone calls in a timely manner.

• Check and respond to emails in a timely and professional manner.

• Performs all other assigned duties.

GENERAL DUTIES:

• Conducts self in accordance with the company’s standard values and policies.

• Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels.

The Essential Job Functions and Duties and Responsibilities listed above are not exhaustive. The job functions and duties of this job may vary depending upon the specific nature and needs of the department, including size, location and services offered. At some locations, employees may not perform all of the job functions or duties listed above. At other locations, employees may perform some or all of the job functions or duties listed above and, in addition, may be required to perform other job functions or duties as directed. In addition, given the nature of its business, MMRG retains the right to modify the essential job functions and duties of this position at any time.

METHOD AND FREQUENCY OF SUPERVISION:

• Monthly meetings with supervisor. Informal supervision with employee through an open door policy. Employee is expected to ask questions when needed.

Qualifications

Education:

• High School diploma or equivalent

Prior Experience:

• Minimum of 1-2 years of insurance verification, referrals, prior authorization, or eligibility experience required experience preferred.

Skills and Proficiencies:

• Active knowledge of CMS guidelines contracted insurance guidelines and coding policies.
• Demonstrated computer literacy
• Well-organized with attention to detail
• Ability to read and understand oral and written instructions
• Excellent math skills
• Critical thinking skills are strongly preferred
• Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients.
• Professional customer service skills.
• Have a desire and dedication to work with self-discipline.
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.

Physical Abilities:

• Ability to sit for long periods. Work requires walking, bending, standing, sitting, and reaching

Benefits & Perks

Your health, happiness and your future matters! At Vantage Eye Center, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!