Prior Authorization Specialist

4 weeks ago

Jacksonville, United States Center for Orthopedic and Research Excel Full time
Job DescriptionJob Description

Established in 2001, Southeast Orthopedic Specialists is a regional leader in orthopedic medicine. We are dedicated to growing with our patients. Our reach will continue to expand to meet the needs of all patients, present and future. It is our wish to make industry-leading five-star orthopedic care accessible to as many people as possible.

At Southeast Orthopedic Specialists, we are dedicated to taking care of you so you can take care of business Our robust benefits package includes the following:

  • Competitive Health & Welfare Benefits
  • Monthly stipend to use toward ancillary benefits
  • HSA with qualifying HDHP plans with company match
  • 401k plan
  • Employee Assistance Program that is available 24/7 to provide support
  • Employee Appreciation Days
  • Employee Wellness Events

As Southeast Orthopedic Specialists continues to grow, we are hiring Prior Authorization Coordinator for our Southside Clinic

Please see below for the functions and requirements for this position:

GENERAL STATEMENT OF DUTIES

The Prior Authorization Specialist is responsible for completing the pre-registration, registration, eligibility verification, verification of benefits, and pre-certification/documentation processes which involves communicating with patients, and insurance companies to ensure that all appropriate demographic and reimbursement information is accurate prior to the patient’s scheduled appointment.

QUALIFICATIONS
  • High school diploma/GED or equivalent working knowledge preferred.
  • Minimum two to three years of experience in a healthcare environment in a prior authorization capacity. Physical Therapy prior authorization experience is highly preferred.
  • Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
  • Must have Healthcare experience with Managed Care Insurance, requesting authorizations for Insurance, and verifying insurance benefits.
  • In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.

ESSENTIAL FUNCTIONS

  • Obtains benefit verification and necessary authorizations
  • Uses online, web-based verification systems and reviews real-time eligibility responses to ensure the accuracy of insurance eligibility.
  • Creates appropriate referrals to attach to pending visits.
  • Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
  • Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient prior authorizations.

EDUCATION

  • High school diploma/GED

KNOWLEDGE

  • Knowledge of government provisions and billing guidelines including Coordination of Benefits.
  • Advanced computer knowledge, including Windows-based programs.
  • Knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial
    payers, and other funding sources.

ABILITIES

  • Ability to multi-task in a fast-paced environment. Must be detail-oriented with strong organizational skills.
  • Ability to understand patient demographic information and determine insurance eligibility.
  • Ability to type a minimum of 45 wpm.

ENVIRONMENTAL WORKING CONDITIONS

  • Normal office environment

PHYSICAL/MENTAL DEMANDS

  • Requires sitting and standing associated with a normal office environment.
  • Some bending and stretching are required.
  • Manual dexterity using a calculator and computer keyboard.

** This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills,
abilities and working conditions may change as needs evolve. **

QUESTIONS?

CONTACT - HR@SE-ORTHO.COM

#SOS

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