Description: The Insurance Authorization Specialist is responsible for ensuring timely and accurate authorization of medical procedures, treatments, and services. This role involves close coordination with healthcare providers, insurance companies, our Central Billing Office (CBO), and patients to verify coverage and secure the necessary approvals to optimize reimbursement and patient satisfaction. The ideal candidate will possess strong communication skills, attention to detail, and a solid understanding of healthcare insurance processes.

Our Culture: Inspire hope. Build your legacy. Discover a rewarding, fulfilling, well-balanced career at Florida Digestive Health Specialist, LLP. With providers and locations across Florida, FDHS is one of the largest single-specialty, physician-owned GI practices in the state. FDHS was established in 2011 to provide comprehensive, high-quality gastroenterology services and foster advanced research for digestive health problems. With a growing team of nationally acclaimed care centers, providers, and staff, we continue to expand our reach to communities that need our care.

Essential Duties:

• Obtain prior authorizations for medical procedures, treatments, and services by contacting insurance companies and verifying coverage details.
• Accurately enter and update authorization information in the electronic medical record (EMR) system.
• Monitor authorization status and follow up with insurance companies as needed to ensure timely approvals.
• Inform patients of authorization status, coverage details, and any potential out of pocket expenses.
• Work closely with physicians, nurses, and other healthcare providers to gather necessary documentation for authorization requests.
• Collaborate with the Central Billing Office (CBO) to ensure accurate and complete submission of claims.
• Assist billing department with preparation of billing data and medical claim submission to insurance companies.
• Address and resolve any issues or discrepancies related to insurance authorizations.
• Appeal denied authorizations by preparing and submitting appropriate documentation.
• Maintain knowledge of insurance policies, procedures, and regulatory requirements.
• Ensure compliance with all HIPAA regulations and maintain patient confidentiality at all times.
• Other duties as assigned. Please note that the duties and responsibilities outlined in this job description are not exhaustive and may be subject to change at any time to meet the evolving needs of the company. In addition to the responsibilities listed above, employees may be required to perform additional tasks or duties as assigned by management.

Qualifications:

• High School Diploma or equivalent
• Minimum of (2) years’ experience in medical billing, insurance verification, or authorization processes.
• Knowledge: Understanding of healthcare insurance plans, medical terminology, HIPAA regulations, and medical recordkeeping best practices.
• Proficiency in EMR software and basic computer applications (e.g. Microsoft Office)
• Strong organizational skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to maintain effective and organized systems to ensure timely patient flow
• Problem-solving abilities and a proactive approach to tasks

Benefits:

• Competitive salary commensurate with experience.
• Comprehensive benefits package including health insurance, retirement plan, paid time off and paid holidays.
• Professional development opportunities
• Positive and collaborative work environment

Physical Requirements:

Ability to sit for extended periods. Ability to lift and carry files or boxes weighing up to 20 lbs. Ability to use standard office equipment, such as computers, printers, and copiers.

EEO Statement:

It is the policy of Florida Digestive Health Specialists to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law.

When you join FDHS, you become part of a premier team striving to deliver unparalleled, personalized care while treating patients like family. And at FDHS, our patients are at the heart of everything we do. Join our team at FDHS and make a difference in the lives of our patients and employees alike!