HMO Specialist

Job Description

This position is responsible for obtaining authorization for scheduled visits, verify demographics and have insurance knowledge. Insurance requirement for the office visits and in office procedures. Must be able to communicate professionally and through email. Responsible for supporting the team with different work ques, Maintain a close working relationship with clinical partners, ancillary, and patient access department in a clear and respectful manner. Must demonstrate excellent customer service that promotes patient, staff and customer satisfaction and reflect the mission, vision and values of Nemours.

Obtain authorization for scheduled office visits, verify and update demographics, insurance, PCP authorization/referral information when required at each encounter. Work in various work ques assigned. Be a source to the team and community PCP offices. Process referral in the various work ques. Assist in Registration Department when needed.

Essential Functions -

1. Assist patients in obtaining an authorization when they arrive at the clinic without an appropriate authorization and advise clinic of patient status.
2. Communicate with assigned clinics regarding unattainable authorizations.
3. Monitor and respond appropriately and professionally to emails for the DAG email pool.
4. Work-queues: Process encounters via the DAG work-queue daily.
5. Attend daily huddles.
6. All other duties as assigned by supervisor or manager.

Qualifications

High School Diploma

Minimum of 1 year Insurance knowledge and customer service role.

1-3 Years Medical office experience

About Us

As one of the nation's premier pediatric health care systems, we've made a promise to do whatever it takes to prevent and treat even the most disabling childhood conditions. It's a promise that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention.

Equity, diversity, and inclusion guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive environment. All Nemours Associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.

Nemours aspires to have its workforce and providers reflect the rich diversity of the communities we serve. Candidates of diverse backgrounds, race and ethnicity, religion, age, gender, sexual orientation, and those committed to working with diverse populations and conversant in multicultural values are strongly encouraged to apply. Please click here to review Nemours Anti-Racism Statement (nemours.org).

To learn more about Nemours and our commitment to treat every child as if they were our own, visit us at www.nemours.org.

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