Prior Authorization Specialist

North Florida Surgeons • Jacksonville, FL

1d

About The Position

The Prior Authorization Specialist assists patients who need treatment requiring insurance carrier pre-authorization. The specialist interviews patients to assess their medication needs and liaises with insurance companies and nurse managers to obtain prior authorization approval.

The role verifies patient insurance coverage, confirms that necessary visits and procedures are covered, accurately enters data, updates patient benefit information, and maintains accurate insurance records. The specialist serves as a resource to patients by explaining relevant coverage information and uses good judgment when communicating unforeseen issues, such as uncovered procedures, large copayments or coinsurance, or unpaid insurance premiums. The role accesses patient charts only as needed for treatment, payment, and health operations, and follows HIPAA confidentiality standards when accessing or communicating patient information.

Requirements

• High school diploma or equivalent.
• Excellent verbal and written communication skills.
• Ability to interact courteously and professionally with patients and employees.
• Excellent organizational skills and attention to detail.
• Ability to multitask and function well in a fast-paced and sometimes stressful environment.
• Proficiency in working with insurance companies and extensive knowledge of different types of coverage and policies.
• Ability to focus and work quickly.

Nice To Haves

• Healthcare receptionist experience.

Responsibilities

• Verify patient insurance coverage and ensure necessary visits and procedures are covered by the patient’s provider.
• Enter data accurately, update patient benefit information, and verify existing information.
• Maintain accurate patient insurance records and ensure paperwork is processed in a timely manner.
• Interview patients to assess medication needs and liaise with insurance companies and nurse managers to obtain prior authorization approval.
• Provide patients with pertinent information regarding their insurance coverage.
• Use good judgment when contacting patients about unforeseen coverage or payment issues, including uncovered procedures, large copayments or coinsurance, and unpaid premiums.
• Access patient charts only as needed for 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.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED