Authorization Specialist

13 hours ago

Jacksonville, Florida, United States UF Health Full time
Overview

Monday through Friday 8:00 AM TO 5:00 PM

The Authorization Specialist is responsible for obtainment and timely authorization of patient insurance information for
services prior to scheduled appointment on behalf of First Coast Health Alliance physicians. This position utilizes
exemplary customer service skills and acts as a point of contact for patients and providers with regards to benefits
eligibility and authorizations for service coverage.

Responsibilities
  • Responsible for verifying all patients' eligibility, enrollment history, and demographical information. Inputs all information from providers/members into the electronic record.
  • Reviews insurance eligibility information and notates account accurately with co-pay and deductible information.
  • Obtains and tracks insurance authorizations on behalf of the First Coast Health Alliance physicians from all in-network and out-of-network insurance carriers for diagnostic imaging services provided at FCHA member facilities. Completes the process by contacting the insurance company via phone or utilizing available online tools.
  • Screens for LMRP's and identifies when an ABN is required and how to deliver/explain in detail ABN/LMRP process to the patient as well as the need to obtain a signature for service or gather a new order from the physician's office that will meet medical necessity when authorization is not obtained.
  • Acts as point of contact providing assistance on authorization requests to providers and patients by maintaining open lines of communication.
  • Verifies that the procedure and diagnosis code is the same procedure and diagnosis code as the test ordered.
  • Responsible for reading and interpreting a completed physician order (written or electronic) for appropriate handling.
  • Responsible to maintain a three-day window; having all patients registered, insurance verified, pre-certed, completed etc., for those patients that have scheduled appointments.
  • Performs all other duties as assigned by management within job scope.
Qualifications

Education / Training

  • High School Diploma/Equivalent

Experience Requirements

  • 1-year Medical Office, Insurance, Pre-Registration/Authorization

Additional Information:
Knowledge of medical terminology and medical insurance terminology with emphasis on referral and pre-certification
processes required.

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