Prior Authorization and Referral Specialist
Full‑time position located onsite in Oak Brook Terrace, IL with Family Eye Physicians.
As a Prior Authorization and Referral Specialist, you will request and complete authorizations and referrals for our Ophthalmology practice, ensuring the required prior authorizations and referrals are in place ahead of patients’ appointments or procedures.
Key Responsibilities
Review appointment schedules and process prior authorization requests for medical services.
Verify patient insurance coverage and eligibility for requested services.
Monitor schedules for potential issues prior to appointment dates.
Interact with insurance companies to submit authorization requests and follow up on pending approvals.
Contact referring physicians for additional information as needed.
Maintain accurate records of authorization requests and outcomes in the electronic health record (EHR) system.
Assist patients, internal staff, and physicians in understanding authorization requirements and processes.
Collaborate with the billing team to resolve authorization‑related issues and ensure continuity of care.
Provide training and support to new staff on prior authorization procedures.
Prepare reports and analyze data related to authorization trends and outcomes.
Qualifications
High school diploma or equivalent; associate’s degree in a relevant field preferred.
Previous experience (1–2 years) in a prior authorization or medical billing role.
Strong knowledge of insurance portals (Availity, UHC, Humana, Cigna) to submit requests and follow up on pending authorizations.
Strong knowledge of medical terminology, coding, and insurance regulations.
Excellent communication and interpersonal skills.
Detail‑oriented with strong organizational and time‑management abilities.
Proficient in using EHR systems and Microsoft Office Suite; knowledge of Nextech / Practice Plus preferred.
Ability to work independently and as part of a team in a fast‑paced environment.
Seniority level: Entry level
Employment type: Full‑time
Job function: Health Care Provider; Industry: Wellness and Fitness Services