Authorization Specialist HFMG - Neurology

About the role

The Authorization Specialist verifies eligibility, obtains insurance benefits, and ensures pre-certification, authorization, and referral requirements are met prior to the delivery of outpatient, and ancillary services. The Authorization Specialist will determine which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care.

Responsibilities

• Handles the verification of insurance benefits for customers.
• Notifies customers of deductibles and co-insurance requirements.
• Regularly calls insurance companies to follow up on status of the authorization.
• Explores other payment options with customer when needed.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes in accordance to Health First policy and procedures.
• Manage correspondence with insurance companies, physicians, specialists and patients as required and ensures accurate and timely documentation of these contacts.
• Handles incoming and outgoing emails, faxes and phone calls with patients, clinic staff, insurance providers.
• Ensures confidentiality of all health information as required by Florida State statutes and Health Insurance Portability and Accountability Act (HIPAA) guidelines ensuring compliance.

Requirements

• High School Diploma or equivalent
• Two (2) years’ performing Healthcare insurance authorizations OR Two (2) years’ in clinical healthcare with background with CPT and ICD-10 codes.

Qualifications

• Understanding and ability to apply knowledge of CPT and ICD-10 codes.
• Intermediate medical terminology and health insurance knowledge.
• Physical Requirements: Majority of time involves sitting or standing; occasional walking, bending, and stooping. Long periods of computer time or at workstation. Light work that may include lifting or moving objects up to 20 pounds with or without assistance. May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise. Communic