Prior Authorization Specialist

About Riverhills Neuroscience

Riverhills Neuroscience is recognized for over twenty years of delivering outstanding care in the field of neuroscience. The organization is dedicated to comprehensive diagnosis, patient education, and treatment for a range of nervous system disorders and injuries.

Position Overview

The Prior Authorization Specialist role is based in the Norwood office and falls within the Billing department. This hybrid position operates Monday through Friday, 8:00 am to 4:30 pm, featuring two days of in-office work and three days remote following an initial period of on-site training.

Responsibilities

• Oversee and optimize pre-certification, insurance authorization, and referral workflows, maintaining strict adherence to payer protocols.
• Serve as a key liaison with insurance companies, clinical staff, and third-party review organizations to facilitate smooth communication and accurate benefit determinations.
• Handle escalated cases requiring peer-to-peer review, and manage inquiries from providers, patients, and internal teams.
• Secure insurance authorizations promptly for procedures and services, including conducting benefit checks and handling specialty pharmacy orders.
• Maintain and update records such as the ordering spreadsheet, and keep current with insurance coverage changes reflected in schedules.
• Provide patients with information on financial assistance and support programs available to them.

Requirements and Qualifications

• Minimum of 1-2 years’ experience in medical billing or prior authorization, ideally within a healthcare environment.
• Background in Pain Management considered advantageous.
• Hands-on experience utilizing Electronic Medical Records (EMR) systems and practice management software.
• Solid understanding of Medicare, Medicaid, and major health insurance policies and procedures.
• Familiarity with ICD-9/10 medical coding and billing practices, as well as medical terminology.
• Exceptional communication skills, a professional demeanor, sound judgment, and the capacity to relate effectively with staff, patients, medical providers, and vendors.

Compensation

• Hourly pay ranging from $18 to $22, depending on expertise and experience level.

Benefits for Full-Time Employees

• Competitive hourly wage
• 401k plan with profit sharing and 4% company matching contribution
• Comprehensive health, dental, and vision coverage
• Long-term and short-term disability insurance
• Employer-paid life insurance policy
• Paid holidays and over three weeks of paid time off annually
• Financial support for continuing education
• Uniform allowance
• Complimentary parking

Additional Information

• Riverhills Neuroscience is committed to fostering a diverse, inclusive workplace and upholds a strict drug-free policy.