Authorization Specialist (Full Time/Dasys) at Nicklaus Children's Health System in Miami, Florida

Job Description:

Job Summary:
Responsible for insurance verification and obtaining authorization for inpatient, observation, outpatient elective procedures and recurring rehabilitation services including concurrent authorization requests, retroactive authorization modifications, and discharge notifications as appropriate.
 

Minimum Job Requirements

• 
  One year of customer service experience required.
  
  

Job Specific Duties:

• Coordinates the collection and submittal of additional insurance information from clinical/support staff.


• Coordinates with clinical team and communicates managed care requests via established work flows.


• Documents adequate and accurate records of insurance information, denials, and authorizations in the computer system.


• Escalates as appropriate any authorization issues or denials.


• Secures authorization for all inpatient, observation, outpatient elective procedures and recurring rehabilitation services.


• Works with insurance payers and physician practices to accurately request authorization for scheduled procedures.


• Verifies insurance for elective outpatient procedures.


• Calculates patients’ financial responsibility estimates based on insurance benefits and contracts, and provides information to patient/family.


• Notifies patient/family of any deductibles, co-payments, or deposits required at the time of registration, and collects payments.


• Schedules recurring rehabilitation outpatient services.


• Receives incoming pre-registration cue calls, and handles as appropriate.


• Creates and completes pre-registration encounters for outpatient and/or recurring services.


• Monitors continued stay for the fracture clinic patients.


• Reviews, and verifies X-ray orders, and follows up with orthopaedics for missing and incorrect orders.


• Activates and registers patients upon arrival for their appointment.


• Responsible for placing/monitoring patients arriving to the office by using the patient’s tracking system.


• Prints wrists bands and face sheets for all patients.

• Maintains accountability by ensuring compliance thru timely completion of licensures, certifications, all competencies, health requirements (PPD, N95, Flu, etc.), and education requirements.


• Maintains accountability and timekeeping expectations as outlined by MCHS Timekeeping and Attendance policy & procedures.  Ensures behavior is compliant with communication standards.


• Ensures behavior meets and/or exceeds targeted service scores as measured by the Service Index and/or the internal departmental service survey.

• High school education or equivalent preferred


• One year of experience working with medical terminology, procedures, diagnosis codes and insurance strongly preferred


• Able to communicate effectively in English both verbally and in writing in a clear and concise manner


• Fluent in Spanish strongly preferred


• Basic proficiency in Word, Excel and Outlook


• Able to relate cooperatively and constructively with customers and co-workers


• Able to accurately enter and interpret data


• Able to maintain confidentiality of sensitive information


• Accuracy and attention to detail are essential

(EOE DFW)

Updated 4/11/17