Authorizations Specialist- Pediatric Hematology Oncology

KIDZ MEDICAL SERVICE.•Miami, FL

About The Position

SUMMARY: The Authorization Specialist completes authorizations and referrals for all medical services. In addition to reviewing the medical history of potential patients, verifies information provided by referring physicians and verifies insurance coverage. Also monitors the schedule for add-on patients, ensuring there are no conflicts and that prior authorizations are obtained prior to the scheduled appointment or procedure.

Requirements

High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.
Knowledge of medical terminology.
Basic computer skills.
Attention to detail.

Nice To Haves

Associate degree a plus.
Some experience in medical billing or insurance authorization (strongly preferred).

Responsibilities

Verifies information provided by referring physicians and verifies insurance coverage.
Analyze patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization
Ensure patients are eligible for services and that insurance benefits are accurate
Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
Notify providers of potential coverage options
Communicate with patients about the authorization process and any potential delays or financial implications.
May suggest formulary/cheaper alternatives for expensive drugs.
May investigate any serious drug interactions with the requested drug.
Completes authorizations and referrals for our medical services, including appointments and procedures.
Input new patient information and update information in our system
Compile and submit detailed authorization requests to insurance companies, including all necessary documentation
Research and resolve any issues or discrepancies related to authorization requests
Monitor and follow up on authorization requests to ensure timely processing
Investigate insurance denials and resubmit requests or appeal when necessary.
Complete billing documentation
Monitors the schedule for add-on patients, ensuring no conflicts, and we have required prior authorization to move forward with appointment or procedure.
Remain informed about healthcare industry regulations, trends and insurance policies
Assist with other clerical tasks as needed and perform other related duties as assigned by management.