Insurance Authorization Specialist - Full Time - Days

Education High school graduate or equivalent Experience / Qualifications BLS certification through the American Heart Association for Healthcare Providers. Enthusiastic, friendly, patient-focused customer service skills. Exemplary communication skills, written and verbal – comfortable speaking to patients via phone and communicating pertinent information. Professional communication skills required to contact insurance companies to obtain authorizations and to speak with physician offices for additional information. 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, solve problems, and enhance the smooth and efficient flow of the department. Ability to leverage insurance company sites, where possible, to expedite the authorization process. Minimum of 2 year’s 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 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 insurance 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. Determine 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. Provide 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. Answer telephone, respond to questions, direct calls, and document messages. Work cooperatively and provide coverage for responsibilities of co‑workers when assigned or as need arises. Develop and promote 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. Maintain the confidentiality of patient’s records and any related work. Perform other duties as assigned. Team Member Competencies Establishing Relationships Builds effective networks, working relationships, and alliances to collaborate effectively within the department and organization. Relates to all kinds of people regardless of background, finding topics and common interests that build rapport. Peer Support Provides guidance and feedback to help others strengthen knowledge and skills needed to accomplish tasks, solve problems, and perform effectively within the team. Inspiring and Motivating Others Fosters commitment and cohesiveness by facilitating cooperation and working as a team toward goal accomplishments. Builds consensus and ensures cooperation to complete tasks and maintain a positive workflow. Demonstrating Emotional Intelligence Exercises self‑leadership, self‑awareness, and self‑regulation; manages emotions appropriately; leads others by showcasing adaptability, empathy, and social skills. Acting with Integrity Interacts with others directly and truthfully; ensures confidence in individual and organizational motives and representations. Follows through on commitments and communicates intentions clearly. Being a Champion for Change and Innovation Supports people in their efforts to try new things, generates novel and valuable ideas, and uses these ideas to develop new or improved processes. Accepts new ways of doing things and adapts to change. Communicating Effectively Speaks and writes clearly, conveys information concisely and logically, tailors the message to fit the audience, and listens attentively with tact and diplomacy. Promoting Diversity and Inclusion Treats all people with dignity and respect; demonstrates an open‑minded approach to understanding people regardless of gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenges bias and intolerance, develops all‑inclusive groups, and encourages practices that support cultural diversity. Physical Requirements Requires sitting for long periods, stooping, bending, standing, and stretching. Must have manual dexterity for typing and computer data entry. Able to work under stress, independently, with sound decisions, detail orientation, alertness, and self‑motivation. Ability to push/pull up to 40 lbs., carry and lift up to 20 lbs. Threshold Requirements Annual Joint Commission mandatory education requirements, in‑service and health requirements including attendance at new employee orientation. TB/PPD Surveillance Program. Maintenance of required professional licensing and/or certification(s). This is not necessarily an extensive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change. I have reviewed these job requirements and verify that I can perform all essential functions of this position. #J-18808-Ljbffr Jupiter Medical Center