Authorization Specialist HFMG

: Job Requirements

POSITION SUMMARY

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.

PRIMARY ACCOUNTABILITES

1. Handles the verification of insurance benefits for customers.

2. Notifies customers of deductibles and co-insurance requirements.

3. Regularly calls insurance companies to follow up on status of the authorization.

4. Explores other payment options with customer when needed.

5. Process referrals and submit medical records to insurance carriers to expedite prior

authorization processes in accordance to Health First policy and procedures.

6. Manage correspondence with insurance companies, physicians, specialists and patients as

required and ensures accurate and timely documentation of these contacts.

7. Handles incoming and outgoing emails, faxes and phone calls with patients, clinic staff,

insurance providers.

8. Ensures confidentiality of all health information as required by Florida State statutes and Health

Insurance Portability and Accountability Act (HIPAA) guidelines ensuring compliance.

Work Experience

MINIMUM QUALIFICATIONS

• Education: High School Diploma or equivalent
• Work Experience: Any one of the following:

o Two (2) years' performing Healthcare insurance authorizations OR

o Two (2) years' in clinical healthcare with background with CPT and ICD-10 codes.

• Licensure: None
• Certification: None
• Skills/Knowledge/Abilities:

o Proficient in Microsoft Office - Outlook, Word, Excel, PowerPoint.

o Ability to operate and stay organized when using multiple computer screens and website

windows and function effectively in a call center environment.

o Understanding and ability to apply knowledge of CPT and ICD 10 codes.

o 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.

• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.

Benefits

ABOUT HEALTH FIRST

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.