POSITION SUMMARY :

Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of outpatient, and ancillary services.

This position determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care.

• Handles the verification of insurance benefits for customers.
• Notifies customers of deductibles and co-insurance requirements
• Regularly calls insurance companies to follow up on status of the authorization.
• Explores other payment options with customers when needed.
• Applies detailed knowledge of ICD10 and CPT codes.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes in accordance to Health First policy and procedures
• Manage correspondence with insurance companies, physicians, specialists and patients as required and ensure accurate and timely documentation of these contacts.
• Handles incoming / outgoing emails, faxes and phone calls with patients, clinic staff, insurance providers.
• Achieve individual productivity and quality metrics set by management.
• Ensures confidentiality of all health information as required by Florida Statutes and HIPAA guidelines ensuring compliance.

QUALIFICATIONS REQUIRED :

MINIMUM QUALIFICATIONS REQUIRED

Education : High School or GED

Work Experience : Two (2) years performing healthcare insurance authorizations OR Two (2) years as a clinical healthcare provider with background using CPT and ICD 10 codes

Specific Knowledge / Skills / Abilities :

• Working knowledge of Microsoft Office Outlook, Word, Excel.
• Intermediate keyboarding skills.
• Understanding of CPT codes and ICD 10 numbers.
• Intermediate medical terminology.
• Basic insurance knowledge.
• Able to operate and stay organized when using multiple computer screens and website windows and function effectively in a call center environment.

PHYSICAL DEMANDS : Sedentary Work :

Sedentary Work :

• Exerting up to 10 pounds of force occasionally and / or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time.
• Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Job : *Clerical Support

Organization : *Health First Medical Group LLC

Title : HFMG Authorization Specialist - Crane Creek

Location : Florida - Brevard County-Melbourne

Requisition ID : 071665

Last updated : 2024-05-06