Managed Care/Prior Authorization
About Wheaton Eye Clinic Founded over 80 years ago, the Wheaton Eye Clinic is a nationally recognized multi-subspecialty ophthalmology practice that spans the western suburbs of Chicago and is the largest independent ophthalmology clinic in the Midwest. We pride ourselves on serving the community both as a caring eye care provider and as a reputable employer. Our offices are located in Wheaton, Naperville, Hinsdale, Saint Charles, Bartlett, and Plainfield and an ophthalmology-specific ambulatory surgery center at the main office in Wheaton. We currently have 34 ophthalmologists and 6 optometrists in every ophthalmic subspecialty are highly respected in the region and have superb relationships with referring colleagues and health systems. Patients travel to Wheaton Eye Clinic from throughout Northern Illinois, as well as from across the United States. Our referring physicians locally, across the United States, and from many international countries, send their patients to Wheaton Eye Clinic because of its unwavering reputation for exceptional patient care. More than 170,000 patient visits occur each year. Our mission at Wheaton Eye Clinic is to provide comprehensive eye care services of the highest quality and value. This dedication to excellence is founded on how we strive to surpass each patient’s expectations in the delivery of competent, timely, and compassionate eye care. Position Purpose: The Managed Care Representative is responsible for assisting patients with authorization and referral issues to insure proper billing of claims. The Managed Care Representative will review individual insurance policies to ensure billing requirements are being met, provide follow-up on any concerns, determine and obtain necessary authorizations from payers and update accounts as necessary. Key areas include but are not limited to checking eligibility, answer inquiries from patients and clinic staff, handling referrals and authorizations. The Managed Care Representative will utilize expert problem-solving skills to resolve complex problems, taking all steps necessary to ensure full resolution of issues. The hours are Monday through Friday 8-5pm. Remote option after successful 90 day with 1 day onsite. Primary Duties/Responsibilities:
- Determines eligibility for managed care patients including but not limited to HMO plans, Medicare – Medicaid Alignment Initiative plans and Medicaid of Illinois Integrated Care Program plans.
- Ensures authorizations for patient’s managed care plan are obtained in accordance with payer’s policy and required WEC services.
- Verify insurance.
- Register patient in EPIC.
- Enter referral information and scan into EPIC.
- Coordinate appointment.
- Handles all managed care-related patient inquiries, problems and concerns in accordance with clinic objectives and goals.
- Promptly follows up with payers on authorization requests to ensure charges go out in a timely manner for payment.
- Assists with authorizing procedures and laser workques
- Works with clinic providers and staff to ensure proper procedures are being met.
- Handles all other duties as assigned by Manager/Supervisor.
- Attends all department meetings as required.
- Follows all HIPAA and Wheaton Eye guidelines regarding patient privacy.
Position Requirements: Education: Degree/Diploma Required - HS Diploma Experience: High school diploma or equivalent. 1 to 3 years experience preferred. Ideal candidate will have insurance / prior authorization / referral HMO / experience. Knowledge of computers, data entry, spreadsheets, e-mail; strong analytical and troubleshooting skills; outstanding telephone communication and customer service skills; basic knowledge of medical terminology. Epic knowledge a plus Full Time Benefits: Medical Dental Group Life and LTD Paid Time Off Paid Holidays Clothing Allowance Vision Care Benefits Voluntary Benefit Offerings – Life, STD, Critical Illness, Accident 401k Apply tot his job Apply To this Job