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 a seamless customer experience by verifying health insurance information and obtaining necessary authorizations, pre-certifications, and referrals for various medical services. This position requires effective communication with patients and insurance companies, as well as collaboration with clinical staff to enhance service delivery and operational efficiency.

Responsibilities

• Verify health insurance information and obtain authorizations, pre-certifications, and referrals for inpatient, observation, and scheduled outpatient elective services.
• Utilize electronic scheduling, registration, and financial systems to validate health coverage and benefits.
• Maintain proper documentation in all systems and ensure compliance with insurance rules and contract language.
• Communicate with insurance companies to verify coverage, initiate authorizations, and provide necessary clinical documentation.
• Process authorizations electronically using payer portals, fax, or telephone to secure approvals for medical services.
• Determine medical necessity for services using medical criteria software and document findings in patient records.
• Answer telephone inquiries, respond to questions, and direct calls appropriately while documenting messages.
• Collaborate with team members to accomplish common tasks and enhance the smooth flow of the practice.
• Obtain authorization renewals and verify that physician orders are active and compliant with medical necessity requirements.

Requirements

• High school graduate or equivalent education.
• Minimum of 2 years' experience with hospital insurance plans including Medicare, Medicaid, HMO's, and PPO's.
• Excellent typing and computer skills, with familiarity in managed care plans and contractual terms.
• Strong communication skills, both written and verbal, with the ability to interact effectively with patients and insurance companies.
• Capacity to multi-task and work in a team environment to solve problems and enhance departmental efficiency.

Nice-to-haves

• 2-3 years of specialized training in a healthcare setting with knowledge of insurance verification, authorization, and pre-certification processes.
• Familiarity with medical terminology.

Benefits

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