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Authorization Specialist

2 months ago

Melbourne, United States Health First Full time
POSITION SUMMARY

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of outpatient, and ancillary services. This position determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care.

PRIMARY ACCOUNTABILITIES
  • Handles the verification of insurance benefits for customers.
  • Notifies customers of deductibles and co-insurance requirements.
  • Regularly calls insurance companies to follow up on status of the authorization.
  • Explores other payment options with customers when needed.
  • Applies detailed knowledge of ICD10 and CPT codes.
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes in accordance to Health First policy and procedures
  • Manage correspondence with insurance companies, physicians, specialists and patients as required and ensure accurate and timely documentation of these contacts.
  • Handles incoming/outgoing emails, faxes and phone calls with patients, clinic staff, insurance providers.
  • Achieve individual productivity and quality metrics set by management.
  • Ensures confidentiality of all health information as required by Florida Statutes and HIPAA guidelines ensuring compliance.

QUALIFICATIONS REQUIRED

MINIMUM QUALIFICATIONS REQUIRED

  • Education: High School or GED
  • Work Experience: Two (2) years performing healthcare insurance authorizations OR Two (2) years as a clinical healthcare provider with background using CPT and ICD 10 codes
  • Specific Knowledge/Skills/Abilities:
  • Working knowledge of Microsoft Office - Outlook, Word, Excel.
  • Intermediate keyboarding skills.
  • Understanding of CPT codes and ICD 10 numbers.
  • Intermediate medical terminology.
  • Basic insurance knowledge.
  • Able to operate and stay organized when using multiple computer screens and website windows and function effectively in a call center environment.

PHYSICAL DEMANDS: Sedentary Work:

  • Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.
  • Sedentary work involves sitting most of the time.
  • Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.