Insurance Authorization Specialist

Solaris Health Holdings • Largo, FL

411d

About The Position

The Insurance Authorization Specialist at Solaris Health Holdings LLC is responsible for managing the insurance authorization process for Urology services and procedures. This role involves verifying insurance eligibility, securing prior authorizations, and ensuring compliance with medical necessity standards. The specialist will also assist in coordinating with various departments to facilitate the authorization process and maintain accurate documentation in the Practice Management system.

Requirements

• High School Diploma or equivalent required.
• 2+ years experience working medical authorizations.
• Comprehensive understanding of insurance verification, contract benefits, and medical terminology.
• Demonstrates excellent customer service skills.
• Ability to follow policies and procedures and enter data into various electronic systems while maintaining data integrity and accuracy.
• Professional verbal and written communication skills.
• Working knowledge of government and private payer billing regulations.
• Knowledge of EHR, practice management software systems, and Microsoft Office products.
• Ability to handle multiple tasks while meeting departmental deadlines.
• Strong analytical and problem-solving skills.
• Ability to build relationships with patients and display empathy and compassion.

Nice To Haves

• Knowledge of medical terminology, healthcare coding systems, and clinic functions.
• Customer-oriented with ability to remain calm in difficult situations.
• Ability to work independently and manage deadlines.

Responsibilities

• Submits requests for insurance eligibility and prior authorizations for all required insurances based upon plan or insurance contract for all upcoming appointments.
• Secures a referral or order from the physician, if necessary.
• Documents information in Practice Management (PM) system including policy and group number, patient demographics, copays/deductibles, and coinsurance.
• Maintains and updates internal listing of insurance carriers that require authorization.
• Runs account audits to ensure that authorization is being obtained where needed.
• Obtains information about patient insurance coverage, benefits, and eligibility.
• Verifies medical necessity in accordance with CMS standards and communicates relevant coverage/eligibility.
• Identifies patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
• Assists Business Office team with obtaining retro-authorizations.
• Coordinates with Call Center and Offices on prior authorization and eligibility activity as needed.
• Follows appropriate escalation procedures related to authorizations not obtained and contacts stakeholders when there is a threat to payment.
• Performs other position related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Industry: Securities, Commodity Contracts, and Other Financial Investments and Related Activities
• Education Level: High school or GED