Ophthalmic Consultants of Boston
Authorization & Billing Specialists
Ophthalmic Consultants of Boston, Plymouth, Massachusetts, us, 02360
Ophthalmic Consultants of Boston is currently looking for Authorization Billing Specialists to join our team in Plymouth. These specialists provide administrative and billing support to the Retina team and serve as a responsive, accurate resource for providers and clinical staff regarding coverage of various treatment options.
Work schedule: Monday through Friday 8:00–4:30 PM. Positions may be fully onsite or hybrid after training.
Responsibilities
Maintain an accurate, up-to-date understanding of payer policies for retina injectable medications.
Maintain an effective tracking tool for active Prior Authorizations (PA) and their expiration dates.
Submit PA requests and supporting documentation well in advance of upcoming appointments.
Submit urgent PA requests as needed.
Communicate with insurance companies to secure prior approvals and coverage.
Save PA approvals to patient records in Epic and update the Permanent Comments field.
Address denied PAs to secure final approval.
Review periodic reports for outstanding patient balances and connect patients with copay support services.
Register commercially insured patients with manufacturer copay support services; Medicare and Medicare Advantage patients with foundation copay support services.
Order specialty pharmacy (SP) medication and communicate billing procedures to the clinic team.
Manage and review the daily EPIC schedule, using the Day in Accounts Receivable (DAR) to verify coverage, drug, authorization, and balance for all scheduled retina/procedure appointments.
Performance Requirements
Knowledge of organizational policies, procedures, and systems.
Initiative, problem‑solving, and decision‑making ability.
Highly organized, accurate, and proactive with strong reasoning.
Excellent written and verbal communication skills.
Familiarity with retinal diseases, symptoms, and treatments (strongly preferred/required).
Knowledgeable about retinal medications and therapies, including class of drug, approved indications, off‑label usage, risks, benefits, and alternatives (strongly preferred).
Ability to read and understand ophthalmic/retina office notes and assess provider decision‑making.
Prior experience with insurance operations: benefit verification, prior authorization, claims, denials, appeals, medical necessity letters, peer‑to‑peer discussions, buy‑and‑bill versus specialty pharmacy processes, copays, deductibles, and payer coverage policies.
Familiarity with medication manufacturers’ portals/hubs.
Familiarity with required injection paperwork, including consent forms, manufacturer portal registration forms, ABNs, & NEIBs.
Strong coding skills (ICD‑10 & CPT).
Patient communication regarding procedures, coverage, and prior authorization.
Assist billing management with production, productivity, quality, problem resolution, and billing system improvements.
Engage in continuous learning: educational opportunities, professional publications, payer webinars.
Maintain strict discretion and confidentiality.
Other duties as assigned.
Education and Experience
Associate degree in Business Administration or equivalent medical billing experience.
Bachelor’s degree preferred.
3+ years of medical billing experience.
Prior ophthalmology experience strongly preferred.
Prior Epic experience required.
Benefits OCB offers industry‑leading benefits including a 401(k) and comprehensive medical and dental coverage.
Equal Opportunity Employer OCB is an Equal Opportunity Employer.
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Work schedule: Monday through Friday 8:00–4:30 PM. Positions may be fully onsite or hybrid after training.
Responsibilities
Maintain an accurate, up-to-date understanding of payer policies for retina injectable medications.
Maintain an effective tracking tool for active Prior Authorizations (PA) and their expiration dates.
Submit PA requests and supporting documentation well in advance of upcoming appointments.
Submit urgent PA requests as needed.
Communicate with insurance companies to secure prior approvals and coverage.
Save PA approvals to patient records in Epic and update the Permanent Comments field.
Address denied PAs to secure final approval.
Review periodic reports for outstanding patient balances and connect patients with copay support services.
Register commercially insured patients with manufacturer copay support services; Medicare and Medicare Advantage patients with foundation copay support services.
Order specialty pharmacy (SP) medication and communicate billing procedures to the clinic team.
Manage and review the daily EPIC schedule, using the Day in Accounts Receivable (DAR) to verify coverage, drug, authorization, and balance for all scheduled retina/procedure appointments.
Performance Requirements
Knowledge of organizational policies, procedures, and systems.
Initiative, problem‑solving, and decision‑making ability.
Highly organized, accurate, and proactive with strong reasoning.
Excellent written and verbal communication skills.
Familiarity with retinal diseases, symptoms, and treatments (strongly preferred/required).
Knowledgeable about retinal medications and therapies, including class of drug, approved indications, off‑label usage, risks, benefits, and alternatives (strongly preferred).
Ability to read and understand ophthalmic/retina office notes and assess provider decision‑making.
Prior experience with insurance operations: benefit verification, prior authorization, claims, denials, appeals, medical necessity letters, peer‑to‑peer discussions, buy‑and‑bill versus specialty pharmacy processes, copays, deductibles, and payer coverage policies.
Familiarity with medication manufacturers’ portals/hubs.
Familiarity with required injection paperwork, including consent forms, manufacturer portal registration forms, ABNs, & NEIBs.
Strong coding skills (ICD‑10 & CPT).
Patient communication regarding procedures, coverage, and prior authorization.
Assist billing management with production, productivity, quality, problem resolution, and billing system improvements.
Engage in continuous learning: educational opportunities, professional publications, payer webinars.
Maintain strict discretion and confidentiality.
Other duties as assigned.
Education and Experience
Associate degree in Business Administration or equivalent medical billing experience.
Bachelor’s degree preferred.
3+ years of medical billing experience.
Prior ophthalmology experience strongly preferred.
Prior Epic experience required.
Benefits OCB offers industry‑leading benefits including a 401(k) and comprehensive medical and dental coverage.
Equal Opportunity Employer OCB is an Equal Opportunity Employer.
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