Authorization Specialist - Specialty

The Villages, FL

Full Time

Center for Advanced Heathcare at Brownwood (CAHB), 2955 Brownwood Blvd, The Villages, FL

Experienced

About The Villages Health
The Villages Health is a patient-centered primary care driven, multi-specialty medical group with over 800 team members. Our unique care model gives us both the time and resources to truly care for our patients, along with a company culture that supports a healthy work-life balance for our team members. Our purpose, mission and vision is to empower Villagers and the surrounding communities to live out their dreams by keeping them healthy and healing them quickly. Together, we are changing the way healthcare is delivered and are making a positive difference in the lives of our patients and the communities we serve. In doing so, The Villages Health is creating America’s Healthiest Hometown.

Our Full-time Benefits
Medical, Dental & Vision Insurance | Matching HSA & 401k | PTO & Paid Holidays | The Villages Charter School Eligibility | & much more!

Hiring Event
Please bring your resume and join us:

Friday, June 13^th from 9:30 AM to 1:30 PM at The Villages Health Administrative Office (6503 Powell Road, The Villages, FL 32163).

Responsibilities:
This position is responsible for obtaining authorizations for medications, injections & contraceptive devices, scheduling appointments, taking payments, and calculating out of pocket costs based on insurance coverage. These services provide a smooth process for our patients by using “buy and bill” or specialty pharmacy.

Duties and Responsibilities may include, but are not limited to:

Must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, and collaborative.
Demonstrate high proficiency of general medical office procedures, including HIPAA regulations.
Request, track, and obtain authorizations from insurance carriers within time allotted for medical treatment.
Review details and expectations about the authorization and scheduling process with patients.
Contact insurance carriers to verify patient’s insurance eligibility, benefits, and authorization requirements. Must be able to use multiple methods of communication including phone calls, faxing, and portal access to obtain information as required.
Use knowledge of procedure codes (CPT) and diagnosis codes (ICD-10) to request and receive authorizations.
Review clinical documentation to ensure it supports insurance requirements for prior authorization approval. Must be able to effectively communicate any changes in requirements or updates from insurances to the clinical teams and providers.
Demonstrate and apply knowledge of medical terminology to be able to review and answer questions based on information from patient charts including physician office notes, medication orders, procedure documentation, and imaging reports.
Ensure that authorizations are addressed in a timely manner and that clinical teams are notified of any delays in patient care.
Be the main point of contact for patients, providers, clinical staff, insurance companies, and pharmacies for authorization and scheduling status.
Clearly document all communications and contacts with providers and personnel utilizing standard requirements, including proper format.
Organize information in Microsoft Excel for use in tracking authorization status.
Other duties as assigned

Education/Experience Requirements:

High school diploma required.
Certified Medical Assistant certification or Registered Pharmacy Technician certification preferred.
Previous experience in authorization of medical procedures or medications.
One year of insurance benefits and authorization experience required
Knowledge of the health care field and medical office protocols / procedures
Knowledge of billing practices and clinic policies and procedures
Must be able to communicate clearly, accurately, and professionally
Must be able to review office visit notes, imaging reports, lab reports, and other clinical documentation for use in answering clinical questions
Must be able to consistently demonstrate a high level of organization
Must consistently demonstrate strong attention to detail
Must have a background in medical terminology including knowledge of ICD-10, NDC, CPT, and HCPCS codes
Experience with Microsoft Office (specifically Microsoft Excel) is required

Salary is commensurate with experience.

Questions? Contact us at [email protected]

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SELF-ATTESTATION

I certify that I have read and understand the applicant instructions included with this application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions, or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment.

I understand that The Villages Health is an equal opportunity employer and does not unlawfully discriminate in employment and this application form is intended for use in evaluating my qualifications for employment and that this application is not an offer of employment.

I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company and that this application is not intended to constitute a contract of continued employment.

I hereby authorize The Villages Health to contact, obtain, and verify the accuracy contained in this application. I authorize all persons, educational institutions, corporations, companies, agencies, and references to supply any information concerning my background. This includes authorizing the release of information about non-judicial punishment that might have occurred in any branch of the military service. If an official background check of my credit and criminal history is needed, a separate Disclosure Statement and Authorization will be provided to me.

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Authorization Specialist - Specialty

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