November 8, 2024

EYE CLINIC OF WISCONSIN

Wausau

FULL TIME

Prior Authorization Representative

Position Summary
The Prior Authorization Representative is responsible for working with insurance companies to verify insurance coverage and obtain prior authorization for procedures at ECOW/ECLSI.

Principle Duties and Responsibilities

Contact insurance providers by phone, fax or email to verify and obtain prior authorization for patient procedures
Manages and processes prior authorizations included but not limited to Medicare, Commercial, Medicaid, and Workers Compensation for injections, procedures, and other prior authorization needs
Review charges from patient visits listed in the electronic health record for accuracy
Communicate with the scribe or provider when edits are needed to the coding in the EMR
Post patient payments and insurance payments into patient accounts
Manages and processes authorization denials and appeals
Other duties as assigned based on business and operational needs

Work Relationship and Scope
The Prior Authorization Representative reports directly to the Business Services Manager.

Knowledge, Skills, and Abilities

College Degree Preferred with 2 years of experience in insurance or claims processing in a medical setting
An understanding of Medical Terminology
Detailed oriented with the ability to manage multiple priorities and work in a highly active environment
Ability to abide by all HIPAA privacy laws
Ability to problem solve, work independently and handle repetitious work
Ability to handle fluctuating daily work assignments based upon changes in patient volume
Requires exceptional communication skills and the ability to deal with people in all levels of society in a calm, courteous manner - providing compassion without judgement in regard to patient finances
Proper telephone etiquette, knowledge of computer usage (including typing accurately), copy machine, fax and web-based applications (Microsoft Office)
Clear, professional communication (written and verbal) is a necessity

Work Conditions
Work is generally performed at the main clinic; 800 N. First Street, Wausau, WI. Hours of work will be dependent on the needs of the Clinic. Requires the ability to sit or stand for extended periods of time. Occasional lifting (30 pounds), bending, stooping, pushing, pulling, and climbing stairs is required.

Acknowledgement
This job description describes the general nature and level of work performed by the employee assigned to this position. It does not state or imply that these are the only duties and responsibilities assigned to the job. The employee may be required to perform other job duties as requested by the Administrator or Board President. All requirements are subject to change over time. Reasonable accommodations will be made to those individuals with a disability.