Prior Authorization Specialist

North Florida Surgeons, P.A.•Jacksonville, FL

About The Position

The Prior Authorization Specialist assists patients who need treatment requiring pre-authorization from their insurance carrier. The specialist interviews patients to assess their medication needs and coordinates with insurance companies and nurse managers to obtain prior authorization approval. The role also verifies insurance coverage, maintains accurate patient benefit information and records, and provides patients with information about their coverage.

Requirements

High school diploma or equivalent.
Excellent verbal and written communication skills.
Ability to interact with patients and employees courteously and professionally.
Excellent organizational skills and attention to detail.
Ability to multitask and function well in a fast-paced and sometimes stressful environment.

Nice To Haves

Healthcare receptionist experience.

Responsibilities

Verify patient insurance coverage and ensure necessary visits and procedures are covered by the patient's provider.
Accurately enter data, update patient benefit information, and confirm that existing information is accurate.
Work with insurance companies and understand different types of coverage and policies.
Manage multiple projects while maintaining organized and accurate patient insurance records.
Process paperwork quickly and in a timely manner.
Provide patients with pertinent information regarding their coverage.
Use good judgment when contacting patients about unforeseen issues, such as an uncovered anticipated procedure, a large co-pay or co-insurance, or an unpaid insurance premium.
Access patient charts as needed, limiting access to information related to treatment, payment, and health operations.
Comply with HIPAA confidentiality standards when accessing or communicating patient information.
Perform other duties as assigned by a supervisor, manager, or physician.