Insurance Authorization Specialist

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education

• High school graduate or equivalent

Qualifications

• Enthusiastic, friendly, patient focused customer service skills.
• Exemplary communication skills, written and verbal - must be comfortable speaking to patients via phone and successfully communicate pertinent information.
• Professional, effective communication skills required to contact insurance companies to obtain insurance authorizations and physician offices for additional information, as necessary.
• Must be a 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 to solve problems and enhance the smooth and efficient flow of the department.
• Ability to leverage insurance company sites, where possible, to expedite, authorization process.

Experience

• Minimum of 2 year's experience with medical groupinsurance 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 authoriztion 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.
• Familiarty 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 Insurance Authorization 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 insurances 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.
• Determines 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.
• Provides 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.
• Answers telephone, responds to questions, directs calls, and documents messages.
• Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as need arises.
• Develops and promotes the use of 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.
• Maintains the confidentially of patient's records and any related work.
• Performs other duties as assigned.