Prior Authorization & Insurance Eligibility Verification Specialist Ophthalmology

Experience: 2 3 Years
Employment Type: Full-Time

Job Summary

We are looking for an experienced Prior Authorization & Insurance Eligibility Verification Specialist with healthcare/ophthalmology experience to support U.S.-based eye care operations.

Key Responsibilities

- Verify patient insurance eligibility, benefits, copays, deductibles, and coverage limits.
- Process and follow up on prior authorization requests with insurance payers.
- Submit required clinical documentation and track approvals, denials, and expiration dates.
- Identify and resolve insurance, payer ID, and plan-related discrepancies.
- Communicate with patients regarding insurance advantages and appointment-related requirements.




- Maintain accurate authorization and eligibility records.
- Coordinate with the practice team regarding pending cases and missing documentation.

Requirements
- 2 3 years of hands-on experience in Prior Authorization and Insurance Eligibility Verification.
- Ophthalmology/Optometry experience preferred.
- Knowledge of Commercial, Medicare, and Medicaid payers.
- Experience with EHR/Practice Management systems and payer portals.
- Strong communication skills and good knowledge of U.S. healthcare insurance processes.
- NextTech/NextGen experience is a plus.
- Healthcare academic background such as PharmD, MHA, MBBS, or similar is preferred.

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📌 Prior Authorization & Insurance Eligibility Verification Specialist – Ophthalmology (Telangana)
🏢 Staffingly
📍 Telangana