Job Overview The RCM Insurance Verification & Authorization Coordinator at US Eye plays a vital role in our Revenue Cycle Management (RCM) team, ensuring the accuracy and efficiency of insurance-related processes for our network of ophthalmic practices. This position involves verifying patient insurance coverage, securing prior authorizations for procedures, and collaborating with clinical and billing staff to minimize claim denials and optimize reimbursements. As a key contributor to our financial operations, you will help deliver exceptional patient care by streamlining administrative workflows in a fast-paced healthcare environment. Key Responsibilities You will be responsible for conducting thorough insurance eligibility verifications for all scheduled patient appointments, utilizing payer portals, phone calls, and electronic systems to confirm coverage details, deductibles, and copays. Securing prior authorizations for surgical procedures, diagnostic tests, and specialty treatments is a core duty, involving submission of clinical documentation, follow-up with insurers, and resolution of any issues to prevent delays. You will review patient demographic and insurance information for accuracy, identify potential billing errors, and communicate findings to the appropriate teams. Additionally, you will track authorization statuses, maintain detailed records in our practice management system, generate reports on verification outcomes, and assist with appeals for denied claims. Collaboration with front office staff, providers, and coders is essential to ensure compliance with HIPAA, Medicare, and Medicaid regulations while supporting high-volume ophthalmology practices. Required Qualifications A high school diploma or equivalent is required, with an Associate's or Bachelor's degree in Healthcare Administration, Medical Billing, or a related field strongly preferred. Minimum of 2 years of experience in medical insurance verification, prior authorizations, or revenue cycle management within a healthcare setting, ideally in ophthalmology or specialty care. Proficiency in EHR/EMR systems such as NextGen, Epic, or eClinicalWorks, along with insurance portals like Availity, Payer Express, and Change Healthcare. Certification as a Certified Professional Coder (CPC) or Certified Medical Insurance Specialist (CMIS) is a plus. Skills Strong organizational and multitasking abilities to handle high-volume tasks with attention to detail and accuracy. Excellent communication skills, both verbal and written, for interacting with patients, insurers, and internal teams. In-depth knowledge of medical terminology, CPT/ICD-10 coding, and insurance policies including Medicare, Medicaid, and commercial payers. Analytical mindset for problem-solving claim issues and proficiency in Microsoft Office Suite, especially Excel for reporting. Ability to thrive in a team-oriented environment while maintaining confidentiality and adapting to changing regulations. Company Info US Eye is a premier network of ophthalmology and optometry practices dedicated to providing advanced eye care across the United States. With a commitment to innovation, patient-centered service, and clinical excellence, we operate state-of-the-art facilities equipped with cutting-edge technology for comprehensive vision health solutions. Benefits We offer competitive compensation, comprehensive health, dental, and vision insurance, 401(k) with company match, paid time off, and professional development opportunities. Employees enjoy a supportive work culture with team-building events and access to continuing education. Growth Opportunities Advance your career within our expanding organization through internal promotions, specialized training in RCM and coding, and leadership development programs. Join a dynamic team where your contributions directly impact patient outcomes and organizational success.