Insurance Authorization Specialist

3 weeks ago

Jupiter, United States Jupiter Medical Center Full time

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education: High School Graduate or Equivalent

Qualifications:

• Enthusiastic, friendly, patient focused customer service skills.

• Exemplary communication skills, written and verbal - must be comfortable speaking to patients via phone and successfully communicate pertinent information.

• Professional, effective communication skills required to contact insurance companies to obtain insurance authorizations and physician offices for additional information, as necessary.

• Must be a team player with ability to collaborate interdepartmentally and with clinical staff.

• Capacity to multi-task with computer programs while providing patients the highest level of care and attention.

• Works well in a team environment to accomplish common tasks to solve problems and enhance the smooth and efficient flow of the department.

• Ability to leverage insurance company sites, where possible, to expedite, authorization process.

Experience:

  • Minimum of 2 years' experience with medical group insurance plans including Medicare, Medicaid, HMO's and PPO's.
  • Excellent typing and computer skills.
  • Familiarity with area managed care plans and contractual terms.
  • Epic experience preferred.
  • Pain management authorization experience preferred.
  • Ability to self-direct and exercise independent judgment in situations requiring follow-up and discussions with clinical staff and/or other areas of Patient Access to ensure completion of required authorizations/approvals for payment services and enhanced customer service.
  • 2-3 years of specialized training in a health care setting with demonstrated knowledge of insurance verification, authorization and pre-certification process preferred.
  • Familiarity with medical terminology.
Position Summary:

The Insurance Authorization Specialist will be responsible for delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence.

The Insurance Authorization Specialist is responsible for verifying health insurance information and obtaining authorizations, pre-certifications, and/or referrals for inpatient, observation, and scheduled outpatient elective services.
  • Utilizes electronic scheduling/registration/financial systems, payer's websites, and recorded calls to validate health coverage and benefits in processing approval for medical services.
  • Maintains proper documentation in all systems.
  • Works closely with Managed Care and understands health insurances rule sets, manuals, and contract language.
  • Contact patient's insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted prior authorizations.
  • Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations.
  • Determines medical necessity for services using medical criteria software.
  • Review and verify all insurance plans and confirm patient's eligibility and benefits.
  • Document findings and all pertinent information in the notes section of the patient's record and appointment notes in a thorough and clear manner.
  • Provides documentation upon request from insurance companies.
  • Works well in a team environment to accomplish common tasks to solve problems and enhance the smooth and efficient flow of the practice.
  • Answers telephone, responds to questions, directs calls, and documents messages.
  • Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as need arises.
  • Develops and promotes the use of effective methods of communicating with physicians, managers, peers, trainees, and staff on a regular basis.
  • Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity and or detailed written order is in place.
  • Maintains the confidentially of patient's records and any related work.
  • Performs other duties as assigned.

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