Authorizations Specialist - Specialty Drugs

Job Summary
Retina-Vitreous Surgeons of Central New York is dedicated to providing highly skilled, state-of-the-art, and compassionate care for all of our patients.

We are seeking a dedicated and detail-oriented Authorizations Specialist specializing in Specialty Drugs to join our team.

Responsible for determining if patients are eligible to receive scheduled treatment and obtaining insurance prior authorizations for injectable medications.

The ideal candidate will possess a strong understanding of medical office procedures, and insurance authorization protocols. In this role, you will be responsible for managing prior authorization requests for specialty medications, ensuring compliance with regulatory standards such as HIPAA, and facilitating seamless communication between healthcare providers, insurance companies, and patients. Your expertise will help streamline the approval process for complex drug therapies, ultimately supporting optimal patient care.

Responsibilities

• Review and verify patient’s insurance coverage
• Confirm payer guidelines for treatment have been met (diagnosis, step therapy, etc)
• Request prior authorization for scheduled drug using various insurance portals or confirm authorization on file is still valid
• Work with Benefits Specialist to determine patient’s financial responsibility for treatment (copay, coinsurance, etc) and whether enrollment in a foundation is needed
• Answers calls from staff regarding insurance/authorizations and provides support to the clinical staff regarding injections
• Performs other related duties as assigned

Education and Experience:

• HS diploma or GED required
• Knowledge of ICD-10 and CPT codes
• Experience in prior authorizations for specialty drugs is highly desired
• Experience in a retina or ophthalmology practice is highly desired

Equipment, Machines and Software Used:

Ability to operate a computer, copier/fax and telephone

Computer Software: Nextech: P+ and IntelleChart Pro; Microsoft Office: Outlook, Excel and Word

Knowledge, Skills, and Abilities:

• Computer proficiency including word processing, data entry, spreadsheets, and generating reports using standard software applications.
• Adherence to HIPAA requirements and compliance standards.
• Ability to maintain patient confidentiality.
• Ability to maintain accurate records and data files.
• Problem solving skills.
• Some analytical ability to gather and summarize data, find solutions to various administrative problems, and prioritize work.
• Ability to multi-task in a fast-paced environment.
• Strong interpersonal and communication skills and the ability to work effectively with individuals at all levels of the organization structure.
• Skill in organizing and establishing priorities.
• Ability to create, compose, and edit written materials.
• Must be detail-oriented and well organized.

Physical and Mental Requirements:

Ability to sit, stand, walk, talk, hear, and perform repetitive hand and wrist motions

Ability to bend, crouch or kneel when necessary

Ability to exert up to 30 pounds occasionally; up 10 pounds frequently

Minimal force constantly when moving objects

Requires close mental and visual attention when working with computers, telephones and documentation systems.

Pay: From $22.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person