Insurance Representative

Ascension•Jacksonville, FL

2d•$18 - $25•Remote

About The Position

This role is responsible for securing prior authorizations and coverage by verifying patient eligibility, evaluating medical necessity, and obtaining pre-authorizations. The representative will coordinate in-network referrals and scheduling, ensuring appointments align with payer matrices and preferred network guidelines. They will also navigate managed care and payer policies, staying current on regulations and procedures to assess financial responsibility. Additionally, the role involves advocating for patients by communicating coverage details and authorization statuses, proactively resolving barriers to care, and maintaining accurate EMR documentation with comprehensive details.

Requirements

High school diploma or equivalent required.
1+ years related experience required.
Insurance & Authorization Expertise with 2+ years of hands-on experience navigating medical insurance benefits, payer portals, prior authorizations, clinical documentation, and medical terminology.
Critical Thinking & Autonomy skills including strong critical thinking skills, decisive judgment, and the proven ability to manage high-stress situations with minimal supervision.

Responsibilities

Verify patient eligibility through online payer portals.
Evaluate medical necessity requirements.
Obtain necessary pre-authorizations for provider-ordered procedures and services.
Schedule patient appointments within required clinical timeframes.
Ensure all referrals strictly align with payer matrices and preferred network guidelines.
Stay current on evolving insurance regulations, portal updates, and referral procedures.
Accurately assess financial responsibility and prevent coverage gaps.
Update patients, clinical providers, and insurance reps on authorization statuses.
Proactively resolve barriers to care or notify parties if a service is denied.
Log comprehensive, audit-ready details into the patient’s electronic medical record (EMR), including authorization numbers, coverage limits, restrictions, and appointment notes.