Job Abstract

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

• Verifies insurance/managed care plans for eligibility for all of the insurance plans listed in the patient account and documents information in TxM and Athena.
• Uses Athena to confirm eligibility and/or contacts the payer directly and documents the outcome in the patient account.
• Obtain prior authorizations for each infusion plan listed on each day in a timely manner to as not to delay treatment for patients.
• Will pre-certify all patient infusions and injections by confirming their insurance/managed care plan eligibility in addition to confirming whether prior authorization for visits and treatments are necessary.
• Advises staff of any insurance plan updates.
• Authorize specialty pharmacy drugs for patients and maintains an accounting through the PBM log system.

Required Qualifications:

• High School graduate or equivalent
• Prior medical office experience required
• Prior Authorization Certified Specialist (PACS) preferred
• Knowledge of insurance company/managed care organization constraints related to the retinal practice’s office procedures, visits, testing and drug therapy.
• prior authorization experience of one year strongly preferred
• Must have a high level of customer service, interpersonal and organizational skills
• Must be able to multi-task and handle a fast-paced busy environment
• Strong working knowledge of basic computer programs, and good typing skills
• Ability to plan, prioritize, and complete delegated tasks in a reasonable span of time
• Ability to work independently and as a member of a team
• This position may require cross-coverage of other positions, as needed, and therefore a measure of flexibility to respond adequately to changing demands is required

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families.  Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.