Virginia Eye Institute
Business Office, 2235 Staples Mill Road, Richmond, Virginia, United States of America
Job Description
Posted Tuesday, November 25, 2025 at 5:00 AM Case Management Specialist The Virginia Eye Institute is hiring! VEI is a large and dynamic multi-specialty practice of ophthalmologists and optometrists in the Richmond, VA area, including eight locations and an ambulatory surgery center. We are searching for a Case Management Specialist to join our Revenue Cycle department. We are looking for dependable candidates with outstanding mindfulness skills and excellent customer service. The ideal candidate will be a team-player, initiative-taker, friendly, motivated, organized, and can work independently while sustaining a team environment. A caring demeanor and the ability to build and support patient rapport is critical. The candidate must be highly productive, eager to learn, and motivated to succeed. The Case Management Specialist handles obtaining the necessary insurance authorizations for patients requiring treatment or surgery. They coordinate with the patient and liaise with the provider and insurance carriers to obtain prior authorizations. RESPONSIBILITIES: Understands insurance eligibility within EMR system and in multiple payer websites. Understand payer clinical/policy guidelines for prior authorization process. Request, track, and obtain prior authorization from insurance carriers within the time allotted for medical services. Obtain prior authorization for physician and facility services. Appeal insurance carrier when prior authorization is denied. If instructed by the payer, communicate with clinic staff in a prompt manner when additional/alternative medical guidelines must be followed. Document necessary information in EMR (eCW) on authorizations and actions. Maintain knowledge of the top office and outpatient surgical procedures that require prior authorizations. Maintain knowledge of copay assistance programs, communicate with patient as needed within timely turnover prior to procedure. Maintain knowledge of processes to obtain authorizations (buy and bill, specialty pharmacy, step therapy, benefit investigations, financial assistance). Discuss medications, insurance, and prior authorization with patients. Communicate any insurance changes and trends amongst RCM team. Other duties as assigned. REQUIREMENTS: Thorough understanding of Insurance eligibility ICD-10, HCPCS and CPT knowledge Windows-based software applications (i.e., Word, Excel) Knowledge of medical terminology Strong interpersonal communication skills, including the ability to set up and support effective relationships with payers, physicians, management, and co-workers. Demonstrates mindfulness. Maintains cheerful outlook and friendly demeanor with other team members.
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Posted Tuesday, November 25, 2025 at 5:00 AM Case Management Specialist The Virginia Eye Institute is hiring! VEI is a large and dynamic multi-specialty practice of ophthalmologists and optometrists in the Richmond, VA area, including eight locations and an ambulatory surgery center. We are searching for a Case Management Specialist to join our Revenue Cycle department. We are looking for dependable candidates with outstanding mindfulness skills and excellent customer service. The ideal candidate will be a team-player, initiative-taker, friendly, motivated, organized, and can work independently while sustaining a team environment. A caring demeanor and the ability to build and support patient rapport is critical. The candidate must be highly productive, eager to learn, and motivated to succeed. The Case Management Specialist handles obtaining the necessary insurance authorizations for patients requiring treatment or surgery. They coordinate with the patient and liaise with the provider and insurance carriers to obtain prior authorizations. RESPONSIBILITIES: Understands insurance eligibility within EMR system and in multiple payer websites. Understand payer clinical/policy guidelines for prior authorization process. Request, track, and obtain prior authorization from insurance carriers within the time allotted for medical services. Obtain prior authorization for physician and facility services. Appeal insurance carrier when prior authorization is denied. If instructed by the payer, communicate with clinic staff in a prompt manner when additional/alternative medical guidelines must be followed. Document necessary information in EMR (eCW) on authorizations and actions. Maintain knowledge of the top office and outpatient surgical procedures that require prior authorizations. Maintain knowledge of copay assistance programs, communicate with patient as needed within timely turnover prior to procedure. Maintain knowledge of processes to obtain authorizations (buy and bill, specialty pharmacy, step therapy, benefit investigations, financial assistance). Discuss medications, insurance, and prior authorization with patients. Communicate any insurance changes and trends amongst RCM team. Other duties as assigned. REQUIREMENTS: Thorough understanding of Insurance eligibility ICD-10, HCPCS and CPT knowledge Windows-based software applications (i.e., Word, Excel) Knowledge of medical terminology Strong interpersonal communication skills, including the ability to set up and support effective relationships with payers, physicians, management, and co-workers. Demonstrates mindfulness. Maintains cheerful outlook and friendly demeanor with other team members.
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