HMO Specialist I
6 days ago
Nemours Children's Health is seeking a skilled professional to fill the role of HMO Specialist.
Job Summary:
The HMO Specialist will be responsible for verifying insurance eligibility and benefits, obtaining authorizations for office visits and procedures, and communicating with clinical teams and patient families. This role requires strong customer service skills, attention to detail, and the ability to work independently as part of a team.
Key Responsibilities:
- Verify insurance eligibility and obtain referrals/authorizations for office visits and procedures.
- Communicate with assigned clinical teams and patient families about unattainable or delayed insurance referrals/authorizations.
- Monitor voice mail and return calls as appropriate for the main HMO phone line.
- Process encounters via the DAG work queue daily.
- Perform other duties as assigned by supervisor or manager.
Requirements:
- High School Diploma or equivalent required.
- One year of specialized training beyond high school required.
- Customer service and healthcare experience preferred.
- One to three years' experience in medical offices, call centers, referral, or authorization experience.
- EPIC and prior psychology/neuro-psychology authorization/referral experience preferred.
What We Offer:
Nemours Children's Health is a leading healthcare provider dedicated to delivering exceptional patient care and service. As an HMO Specialist, you will have the opportunity to work with a talented team of professionals who share your commitment to excellence.
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