Prior Authorization Representative (Healthcare) - Full-time / Part-time

Looking for a Vision Prior Authorization Representative

MUST be proficient in Excel and understand medical terminology.

Position Overview:

The Prior Authorization Representative will focus on the coordination of the prior authorization process by responding to telephone inquiries and faxes from members and/or providers for ophthalmology/optometry services. The Prior Authorization Representative will coordinate durable medical equipment, nonstandard eyewear and services authorization. They will also assist in the routine verification of eligibility and confirmation of benefits.

Job Function:

• Answers calls from physician office, and patients using exemplary customer service skills.
• Accurate entry of required information for authorization of surgical requests according to set plan guidelines
• Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes [without the need for interpretation] and follow establish procedures for authorizing request or referring request for further review.
• Respond to telephone inquiries from members and/or providers for Optometry and Ophthalmology services as well as DME.
• Verification of eligibility, confirmation of benefits, facilitation of the referral/authorization processes.
• Direct communication with the Medical Director with regard to surgical authorizations and non-standard services
• Preparation and coordination of approval and denial letters.
• Direct communication with Health Plans with regard to facility authorization and denials.
• Maintain patient confidentiality as defined by state, federal and company regulations.
• Other duties as assigned

About Aerotek: Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit aerotek.com. Aerotek is acting as an Employment Agency in relation to this vacancy.