Overview
Join a growing dermatology team as a Revenue Integrity Specialist focused on prior authorizations and referrals. This newly created role is responsible for building and improving authorization workflows that support patient access, provider efficiency, and the financial health of a multi-site dermatology practice.
What You'll Do
- Serve as the subject matter expert for insurance prior authorizations and referrals.
- Obtain, submit, monitor, renew, and document prior authorizations.
- Coordinate referrals, including Veterans Affairs Community Care authorizations.
- Review provider schedules to identify authorization requirements before patient appointments.
- Track approvals, denials, renewals, and payer deadlines.
- Assist with appeals and retroactive authorizations when appropriate.
- Work with providers, nursing staff, scheduling, patient service representatives, billing, and leadership.
- Obtain and organize clinical documentation required for insurance approvals.
- Maintain accurate documentation within Athena EMR.
- Support revenue cycle initiatives by reducing authorization-related claim denials.
- Monitor work queues and identify process improvement opportunities.
- Develop standardized authorization workflows and payer reference guides.
- Stay current on payer policy changes and communicate workflow updates across departments.
Work Schedule
- Monday through Friday
- 8:00 AM to 4:30 PM
- No weekends
- In person
Requirements & Qualifications
Required Qualifications
- High school diploma or equivalent.
- 3+ years of experience in one or more of the following:
- Prior authorizations
- Insurance verification
- Medical billing
- Revenue cycle
- Experience working with commercial insurance, Medicare, Medicare Advantage, Medicaid, managed care organizations, and Veterans Affairs Community Care.
- Strong understanding of medical terminology.
- Experience using electronic medical records; Athena experience preferred.
- Proficiency with Microsoft Office.
Preferred Qualifications
- Experience in dermatology or surgical specialties.
- Experience with revenue cycle or medical billing.
- Experience with biologic medication authorizations.
- Experience with specialty pharmacy authorizations.
- Knowledge of CPT, ICD-10, and HCPCS coding.
- CPB, CRCR, or other revenue cycle certifications.
Benefits & Perks
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Short-term disability insurance
- Critical illness insurance
- Accident expense insurance
- Employee Assistance Program (EAP)
- Flexible Spending Account (Dependent Care)
- Paid time off (PTO)
- Paid sick time
- 401(k)
- SEP IRA
- Edvest 529 Program
- Employee referral program
Additional Perks
- Competitive compensation
- Opportunity to help build and shape the revenue integrity program
- Collaborative leadership team
- Supportive team environment
- Professional growth opportunities
- Meaningful work that improves patient access and protects organizational revenue
Location
Wisconsin, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago
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