Physician Practice Representative- Pediatric Hematology/Oncology

Job Description

Job Description

SUMMARY: Join a compassionate and mission-driven team as a full-time Physician Practice Representative supporting a busy pediatric hematology/oncology practice at Palm Beach Children’s Hospital, located within St. Mary’s Medical Center. This position is ideal for someone who thrives in a fast-paced healthcare environment, enjoys multitasking, and takes pride in delivering exceptional patient support. You’ll play a key role in managing insurance verification, scheduling new and follow-up appointments.

• Inputs new patient information and updates information in our EMR system
• Analyzes patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization
• Ensure patients are eligible for services and that insurance benefits are accurate
• Notifies providers of potential coverage options
• Communicates with patients about the authorization process and any potential delays or financial implications.
• Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
• Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation
• Completes/obtains authorizations and referrals for services, including appointments, procedures, infusions, and medications
• Researches and resolves any issues or discrepancies related to authorization requests
• Monitors and follows up on authorization requests to ensure timely processing
• Investigates insurance denials and resubmit requests or appeals when necessary.
• Monitors schedule for potential issues
• Remains informed about healthcare industry regulations, trends and insurance policies
• Performs other related duties as assigned by management.

QUALIFICATIONS:

• High school diploma or general education degree (GED), or 2+ years related experience and/or training, or equivalent combination of education and experience.
• Computer skills required: Microsoft Outlook, Word, Excel and Adobe; Experience working with medical practice management software a plus.
• Other skills required:
  1. Experience working in a physician practice.
  2. Knowledge of medical terms and medical insurance
  3. Experience in requesting/submitting prior authorization for various diagnostic exams, prescriptions, etc.
  4. Professional demeanor and appearance.
  5. Strong interpersonal and communication skills.
  6. Meticulous attention to detail.
  7. Proficient in Microsoft Office Suite (Word, Excel, Outlook)

JOB TYPE / WORK SCHEDULE:

• This is a full-time position, in-office position
• Standard office hours are Monday through Friday, 8:00 a.m. – 4:30 p.m.
• Bilingual Preferred

Competitive pay and full benefits package, including 401(k), health, dental, vision, life, and disability insurance.