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Medical Prior Authorization Coordinator

2 months ago

Jacksonville, Florida, United States Jacksonville Orthopaedic Institute Full time
Job Summary

Jacksonville Orthopaedic Institute is seeking a highly skilled Authorization Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for obtaining prior authorizations for all surgical orders for our San Marco and South clinics.

Key Responsibilities
  • Authorization and Prioritization: Review chart documentation to ensure patients meet medical policy guidelines, prioritize incoming authorization requests according to urgency, and obtain authorization via payer website or by phone.
  • File Maintenance: Maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations.
  • Appeals and Communication: Initiate appeals for denied authorizations, respond to clinic questions regarding payer medical policy guidelines, and confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
  • Patient Communication: Contact patients to discuss authorization status.
Requirements
  • Knowledge and Experience: 2 years of medical prior authorization experience preferred, 2 years of experience in a medical-related field required.
  • Skills and Qualifications: Proficient use of CPT and ICD-10 codes, excellent computer skills, detail-oriented with above-average organizational skills, and ability to multitask and remain focused while managing a high-volume, time-sensitive workload.
  • Education: High School Diploma or GED.
Physical Demands
  • Sitting and Standing: Requires sitting 80%, standing 10%, walking 10%.
  • Manual Dexterity: Requires manual dexterity sufficient to operate a keyboard, mouse, and multiple telephone lines.
  • Computer Vision: It is necessary to view a computer screen for long periods of time.