Authorization Specialist

Summit Health CityMD, New York, NY, Openings : 1,
Apply Here
Job Description : Career opportunities at VillageMD and our operating companies We’re a physician-led, patient-centric network committed to simplifying the complexities of health care and bringing a more connected kind of care. And now we’re proud to say we’re part of the VillageMD family. VillageMD, through its operating companies, provides high-quality, accessible health care services for individuals and communities across the United States, with primary, multispecialty, and urgent care providers serving patients in traditional practice settings, in patients’ homes and online appointments. Committed to serving all patients and working with all payers, VillageMD consistently innovates value-based care, bringing integrated applications, population insights and staffing expertise to its owned and affiliated practices, ensuring high-quality care, better patient outcomes and a reduction in the total cost of care. Through Village Medical , Village Medical at Home , Summit Health , CityMD , Starling Physicians , Westmed , and other practices, VillageMD serves millions of patients throughout their lives, wherever and whenever they need care. Its dedicated workforce of more than 20,000 operates from 770 practice locations and 26 markets. Why become a Villager? When you work at VillageMD, or a VillageMD operating company, you are part of a compassionate community of people who work hard every day to make health care better for all. What makes us different is our village of supportive and inspiring peers who want a meaningful career with impact. The work we do is changing the lives of our patients, our communities, and each other. Together, we are creating better outcomes for all. We’re reimagining health care with a primary care-led, value-based care model. Here, you will be part of a team delivering the care we want to see in the world. It is what drives us to knock down old barriers in health care because every patient, every person and every community deserves better care. Here, you will be at the center of our mission. Your voice will be heard, and you will feel empowered to do what’s best and right for our patients, communities, and each other. To learn more about VillageMD visit our corporate site . Job Description
  • Essential Functions and Job Responsibilities:
    • Verifies insurance/managed care plans for eligibility for all of the insurance plans listed in the patient account and documents information in TxM and Athena.
    • Uses Athena to confirm eligibility and/or contacts the payer directly and documents the outcome in the patient account.
    • Obtain prior authorizations for each infusion plan listed on each day in a timely manner to as not to delay treatment for patients.
    • Contacts patients directly when insurance has terminated or shows ineligible in attempts to obtain new information prior to office visits.
    • Will pre-certify all patient infusions and injections by confirming their insurance/managed care plan eligibility in addition to confirming whether prior authorization for visits and treatments are necessary.
    • Advises both physician and patient of insurance findings and benefit investigations, discusses the possibility of supplemental funding through Chronic Disease Fund and Access to Care Foundation
    • Advises staff of any insurance plan updates.
    • Orders specialty pharmacy drugs for patients and maintains an accounting through the PBM log system.
    Required Qualifications:
    • High School graduate or equivalent
    • Prior medical office experience required
    • Prior Authorization Certified Specialist (PACS) preferred
    • Knowledge of insurance company/managed care organization constraints related to the retinal practice’s office procedures, visits, testing and drug therapy.
    • prior authorization experience of two years strongly preferred
    • Must have a high level of customer service, interpersonal and organizational skills
    • Must be able to multi-task and handle a fast-paced busy environment
    • Strong working knowledge of basic computer programs, and good typing skills
    • Ability to plan, prioritize, and complete delegated tasks in a reasonable span of time
    • Ability to work independently and as a member of a team
    • This position may require cross-coverage of other positions, as needed, and therefore a measure of flexibility to respond adequately to changing demands is required
    Pay Range $22/hr to $27/hr. The provided compensation range is based on industry standards and salary determinations will be made based on numerous factors including but not limited to years of experience and location of position
Total Rewards at VillageMD Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan. Equal Opportunity Employer Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws. Safety Disclaimer Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, or file a complaint at .
Last Date For Apply: 2024-06-12 00:00:00 Job Type : FULL_TIME, Employment Type : FULL_TIMEApply Here