Revenue Cycle Specialist - Prior Authorization

The Revenue Cycle Specialist in the Authorization division is responsible for the day-to-day workflow, and process management of the prior authorization process. This includes facilitating prior authorization request submission, responses, and documentation to ensure payment. Coordination with department leadership will ensure standards are met in accordance with not only department or organization policies and procedures but also with payer submission guidelines.

• Identifies patients and services requiring prior authorization from payer. Collaborate to establish and work to improve
• efficiency of process.
• Prepares and submits prior authorization requests to payers via appropriate method of submission (fax, portal,
• phone, other).
• Monitors outstanding requests for response from payer and identifies and executes appropriate next steps.
• Actively follows up with payers on requests without response and identifies and executes appropriate next steps.
• Works with other departments within organization to resolve outstanding documentation or other process-related
• Keeps updated on all authorization, billing and other payer regulatory or requirement changes.
• Assists billing team with authorization-related claims rejections/denials.
• Completes work within appropriate time to assure compliance with departmental standards.
• Demonstrates knowledge of, and supports, clinic mission, vision, value statements, standards, policies and
• procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Performs other duties as required.
• Assure documentation is in compliance with regulatory agency requirements and best clinical practices.
• Adhere to the organization’s policy, procedures and professional code of ethics
• Self-motivated and self-directed; able to work without supervision.
• Ability to prioritize and manage multiple tasks and competing priorities.
• Exceptional communication and interpersonal skills.
• Analytical and problem-solving skills with attention to detail.
• Proficient computer skills

• EXPERIENCE
  • Prefer Two (2) years’ previous experience in medical billing and/or authorization
• EDUCATION:
  • High school diploma or equivalent; Associate’s degree or higher in accounting, health care administration, finance, business, or related field preferred

BRIGHTVIEW HEALTH BENEFITS AND PERKS: 

• PTO (Paid Time Off) 
• Immediately vested and eligible in 401k program with employer match.  
• Company sponsored ongoing training and certification opportunities. 
• Full comprehensive benefits package including medical, dental, vision, short term disability, long term disability and accident insurance. 
• Tuition Reimbursement after 1 year in related field  
  
  

We offer competitive compensation, comprehensive benefits, and a supportive work environment dedicated to your professional growth and development. 

Ready to shape our future by bringing in top talent? Apply now and be a key player in our success!