Insurance Authorization Specialist - Pain Management

Jupiter Medical Center•Essex, VT

About The Position

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). 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.

Requirements

High School Graduate or Equivalent
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.
Minimum of 2 years’ experience with medical group insurance plans including Medicare, Medicaid, HMO's and PPO's.
Excellent typing and computer skills.
Familiarity with area managed care plans and contractual terms.
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.
Familiarity with medical terminology.

Nice To Haves

Epic experience preferred.
Pain management authorization experience preferred.
2-3 years of specialized training in a health care setting with demonstrated knowledge of insurance verification, authorization and pre-certification process preferred.

Responsibilities

Verify health insurance information
Obtain authorizations, pre-certifications, and/or referrals for inpatient, observation, and scheduled outpatient elective services
Utilize electronic scheduling/registration/financial systems, payer’s websites, and recorded calls to validate health coverage and benefits in processing approval for medical services
Maintain proper documentation in all systems
Work 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
Determine 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
Provide documentation upon request from insurance companies
Answer telephone, responds to questions, directs calls, and documents messages
Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity and or detailed written order is in place
Maintain the confidentially of patient’s records and any related work
Perform other duties as assigned