Insurance Authorization Specialist

Jupiter Medical Center - Jupiter, FL

Full-time - Entry Level

Jupiter, FL

Hospitals

About the position

The Insurance Authorization Specialist plays a crucial role in ensuring that patients receive the necessary authorizations and pre-certifications for medical services. This position focuses on delivering exceptional customer service while verifying health insurance information and collaborating with insurance companies and clinical staff. The specialist is responsible for maintaining accurate documentation and utilizing various systems to process authorizations efficiently.

Responsibilities

• Verify health insurance information and obtain authorizations, pre-certifications, and referrals for medical services.
• Utilize electronic scheduling and financial systems to validate health coverage and benefits.
• Maintain proper documentation in all systems related to insurance authorizations.
• Contact insurance companies to verify coverage and initiate authorizations.
• Process authorizations electronically using payer portals, fax, or telephone.
• 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 pertinent information in the patient's record and appointment notes.
• Answer telephone inquiries, respond to questions, and direct calls appropriately.
• Provide coverage for co-workers' responsibilities as needed.

Requirements

• High school diploma or GED required.
• Minimum of 2 years' experience with hospital insurance plans including Medicare, Medicaid, HMO's, and PPO's.
• Excellent typing and computer skills.
• Familiarity with area managed care plans and contractual terms.
• Ability to self-direct and exercise independent judgment in follow-up situations.
• 2-3 years of specialized training in a healthcare setting preferred.
• Demonstrated knowledge of insurance verification, authorization, and pre-certification processes.
• Familiarity with medical terminology.

Nice-to-haves

• Experience in a healthcare setting with a focus on customer service.
• Strong communication skills, both written and verbal.

Benefits

• Health insurance coverage
• Paid time off
• Retirement savings plan (401k)
• Professional development opportunities