Level I Biller chez Waccamaw Dermatology, LLC

Description

General Summary

The Prior Authorization and Patient Account Specialist is responsible for managing insurance verifications, prior authorizations, and patient account pre-collections. This role ensures timely and accurate processing of insurance documentation, effective communication with patients and providers, and proactive resolution of billing and payment issues. The specialist will maintain detailed records, generate reports, and collaborate closely with clinical and billing teams to support overall revenue cycle efficiency. Exceptional customer service, strong communication skills, and the ability to work both independently and collaboratively are 

essential to success in this role.

Principal Duties and Responsibilities

• Prior Authorization & Insurance Verification
• Verify patient insurance coverage and benefits for services, procedures, and medications, utilizing online portals, phone calls, or other resources.
• Determine if prior authorization is required for scheduled services or prescribed medications.
• Prepare and submit prior authorization requests to insurance companies, ensuring all necessary documentation (including medical records and clinical justifications) is included.
• Track the status of pending authorizations, follow up with insurance companies for approvals or denials, and escalate complex cases as needed.
• Communicate authorization status and potential financial responsibility to patients and referring providers.
• Pre-Collections & Patient Account Management:
• Review patient accounts and identify overdue balances or potential collection issues.
• Proactively contact patients regarding upcoming procedures or services that require payment prior to the date of service.
• Discuss payment options with patients and establish payment plans as appropriate, in accordance with clinic policies.
• Answer patient inquiries regarding billing statements, insurance coverage, and financial responsibility.
• initiate outbound calls to follow up on overdue accounts and discuss payment arrangements.
• Administrative & Reporting:
• Maintain accurate and detailed records of all prior authorization and collections activities within the patient's record.
• Generate and review reports on accounts receivable, pending authorizations, and other relevant metrics. identify and report trends in insurance denials or patient collection issues to management.
• Stay up to date on changes in insurance policies, billing regulations, and collection practices.
• Collaborate with the billing department and other relevant staff to resolve complex billing issues and ensure accurate submission of claims.
• Contributes to team effort by accomplishing all related tasks as needed.
• Provides superior customer service excellence at all times.
• Remains flexible on behalf of the position and the team
• Ability to interact both positively and professionally through multiple departments within the practice.
• Ability to work both independently as well as within a team environment.
• All other duties as assigned

Education and Experience Requirements:

• High School diploma, or equivalent, required.
• Experience in healthcare billing, prior authorization, or collections required
• Strong knowledge of medical terminology, coding (CPT, ICD-10), and healthcare regulations (e.g., HIPAA).
• Demonstrated experience with insurance verification and prior authorization processes.
• Proficiency in electronic health record (EHR) systems and medical billing software.
• Excellent communication skills (written and verbal) and interpersonal skills.
• Strong organizational skills, attention to detail, and ability to manage multiple tasks and deadlines.
• Problem-solving abilities and a proactive approach to addressing challenges.