Job Description

Job Description

Job Description

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We are seeking a detail oriented and patient focused individual to work as a Prior Authorization Specialist at our Edina, MN business office (3 days in office / 2 days work from home).

If you have a passion for providing exceptional patient care, are highly personable, team-oriented, attuned to accuracy and fine detail, and would like to advance your career in the medical field, we would like to talk to you!

Responsibilities for a Prior Authorization Specialist include:

• Coordinate prior authorization requests with insurance companies.
• Use internal technology, reports and spreadsheets to determine if prior authorizations are necessary.
• Request prior authorizations by website and phone.
• Follow up on prior authorization requests.
• Review approved prior authorizations and enters information into patient’s chart and account.
• Review denied prior authorizations and appeals when appropriate.
• Coordinate with clinic staff, physicians and co-workers to accomplish prior authorization process.

Required Skills, Abilities and Attributes for a Prior Authorization Specialist include:

• Medical insurance experience
• Empathy for patients
• Solid understanding of medical terminology
• High attention to detail
• Strong computer experience (multi screens, heavy website navigation, speed and accuracy in moving from window to window, etc.)
• 10 key by touch
• 50 wpm typing
• Experience with AllScripts software
• Problem solving skills
• Love to research and solve puzzles
• Previous prior authorization experience
• Willingness to have tough conversations with insurance companies
• Strong organizational skills
• One year experience with appeal submissions and/or medical billing and coding certificate strongly preferred
• Ability to read and interpret EOBs
• An overall understanding of appeals processes through completion
• Efficient and highly accurate user of applicable information technology and health care management systems
• Meticulous attention to detail and ability to complete the job with minimal errors
• Ability to prioritize and manage time effectively
• Knowledge of HIPAA guidelines
• Excellent oral and written communication skills
• Be an excellent team player who works cooperatively and respectfully with all doctors, supervisors, and co-workers.

We offer excellent compensation and benefits, to include:

• Paid Holidays - 7 days per year
• Personal Time Off (PTO) - 16 days per year
• Health Insurance
• Health Savings Account
• Dental Insurance (100% company paid single coverage)
• Flexible Spending Accounts
• Basic and Supplemental Term Life Insurance (100% company paid single coverage)
• Long Term Disability (free single coverage)
• Long Term Care (100% company paid single coverage)
• Short-Term Disability
• Vision Insurance
• Pet Insurance
• Annual $250 uniform (scrubs and shoes) reimbursement

About Retina Consultants of Minnesota (RCM):

RCM has 9 Minnesota locations - St, Louis Park, Edina, Edina Specialty, Woodbury, Blaine, Duluth, Maplewood, Anoka, and Mankato.

Everything we do…. every decision we make…takes our Guiding Principles into consideration. Our guiding principles are:

• We exist to serve our patients. We will provide the best available medical skills, technology, and service. We will be their advocates. We will care for our patients as if they were members of our family. We will treat our patients with respect, dignity, and kindness.
• We are proud of our dedicated staff. We will strive to provide a rewarding career with opportunity for personal and professional growth. We will promote teamwork. We will provide a respectful and safe working environment.
• We are humbled that other doctors entrust their patients to our care. We will be available when we are needed. We will promptly communicate the results of patient evaluation and treatment. We will respect the referring doctors’ relationships with their patients.
• We recognize that we have a responsibility to our community. We will strive to be desire to perpetually “Learn and Grow”
• Efficient and highly accurate user of applicable information technology and health care management systems
• A good corporate citizen. We will function ethically. We will be prudent in our stewardship of healthcare resources.
• Medical advances are critical to our patients. We will remain at the forefront in the search for new knowledge and treatments of retinal disease. We will participate in clinical research. We will share our knowledge with our patients and referring doctors, and with our retinal colleagues around the world.

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