Referral & Authorization Coordinator

KIDZ MEDICAL SERVICE.•West Palm Beach, FL

3h•Onsite

About The Position

We are looking for an energetic, hard-working, dependable, multi-tasking Medical Insurance Authorization specialist who is passionate about helping others and making a difference.

Requirements

High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.
Some experience in medical billing or insurance authorization (strongly preferred).
Knowledge of medical terminology.
Basic computer skills.
Attention to detail.
Bilingual Required

Nice To Haves

Associate degree a plus.

Responsibilities

Verifies information provided by referring physicians and verifies insurance coverage.
Analyzes patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization.
Ensures patients are eligible for services and that insurance benefits are accurate.
Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions.
Notifies providers of potential coverage options.
Communicates with patients about the authorization process and any potential delays or financial implications.
May suggest formulary/cheaper alternatives for expensive drugs.
May investigate any serious drug interactions with the requested drug.
Completes authorizations and referrals for medical services, including appointments and procedures.
Inputs new patient information and updates information in the system.
Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation.
Researches and resolves any issues or discrepancies related to authorization requests.
Monitors and follows up on authorization requests to ensure timely processing.
Investigates insurance denials and resubmits requests or appeals when necessary.
Completes billing documentation.
Monitors the schedule for add-on patients, ensuring no conflicts, and that required prior authorization is in place to move forward with an appointment or procedure.
Remains informed about healthcare industry regulations, trends, and insurance policies.
Assists with other clerical tasks as needed and performs other related duties as assigned by management.