Procedure Authorization Specialist

4 days ago


Jacksonville, Florida, United States Center for Orthopedic and Research Excel Full time
Job Title: Procedure Authorization Specialist

**Job Summary:**

We are seeking a highly organized and detail-oriented Procedure Authorization Specialist to join our team at the Center for Orthopedic and Research Excel. As a key member of our team, you will be responsible for ensuring that all necessary authorizations and verifications are completed prior to patient appointments.

Key Responsibilities:

  • Obtain Benefit Verification and Necessary Authorizations: Verify patient demographic information and insurance eligibility, including coordination of benefits, to ensure accurate processing of claims.
  • Use Online Verification Systems: Utilize web-based verification systems to review real-time eligibility responses and ensure accuracy of insurance eligibility.
  • Create Appropriate Referrals: Generate referrals to attach to pending visits, ensuring seamless communication with internal and external stakeholders.
  • Respond to Provider and Support Staff Questions: Address inquiries and concerns regarding patient prior authorizations, providing timely and accurate information.

Requirements:

  • High School Diploma/GED: Equivalent working knowledge preferred.
  • Experience in Healthcare: Minimum two to three years of experience in a healthcare environment, with prior authorization experience highly preferred.
  • Communication Skills: Ability to effectively communicate with physicians, patients, and the public, establishing good working relationships with internal and external customers.
  • Knowledge of Insurance Plans: In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.

Working Conditions:

  • Normal Office Environment: Requires sitting and standing associated with a normal office environment.
  • Manual Dexterity: Manual dexterity using a calculator and computer keyboard.


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