Surgery Authorization Specialist (Ophthalmology Exp. Required)

Company Overview

Our Retina Services specialize in advanced ophthalmic treatments, including retinal detachment repair, diabetic retinopathy management, macular degeneration therapy, laser procedures, and complex vitreous surgeries. Committed to applying the latest technological innovations and surgical techniques, our specialists dedicate themselves to delivering personalized and effective patient care.

Job Summary

We are seeking a detail-oriented and experienced Surgery Authorization Specialist with ophthalmology experience to join our team. The ideal candidate will possess a comprehensive understanding of medical insurance processes, prior authorization procedures, and ophthalmic surgical requirements. In this role, you will coordinate insurance approvals for surgical procedures, ensure compliance with healthcare policies, and facilitate seamless communication between patients, providers, and insurance companies to support optimal patient outcomes.

Responsibilities

• Review and verify insurance coverage for ophthalmic surgical procedures, ensuring all authorizations are obtained prior to surgery.
• Collaborate with physicians and clinical staff to gather necessary documentation for authorization requests.
• Utilize knowledge of CPT coding, ICD-9, ICD-10, and ICD coding systems to accurately prepare and submit authorization requests.
• Maintain detailed records of authorization statuses within electronic health records (EHR) systems while ensuring compliance with HIPAA regulations.
• Communicate effectively with managed care organizations and insurance providers to expedite approval processes.
• Stay updated on health insurance policies, medical billing practices, and industry regulations related to ophthalmology surgeries.
• Assist in verifying insurance benefits and coverage details for patients prior to scheduled procedures.
• Ensure adherence to clinical confidentiality policies while managing sensitive patient information using EMR/EHR platforms.

Experience

• Prior experience working as a Surgery Authorization Specialist or similar role within an ophthalmology or medical practice setting is required.
• Demonstrated proficiency in medical office operations, including insurance verification, prior authorization processes, and medical records management.
• Strong knowledge of health insurance policies, managed care protocols, and medical coding (CPT, ICD-9/10).
• Familiarity with electronic health records (EHR) systems and Microsoft Office applications is essential.
• Excellent customer service skills with the ability to communicate clearly with patients, providers, and insurance representatives.
• Understanding of clinical confidentiality policies such as HIPAA is mandatory

This is not a remote position.

Join our dedicated team in providing exceptional ophthalmic care by ensuring smooth surgical authorization processes that support our patients' vision health journey!

Pay: $24.42 - $29.41 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Work Location: In person