Authorization Representative

Florida Orthopaedic Institute; Saint Petersburg (FL); On-site; USD 36,000 - 48,000; Full time

Job summary

Florida Orthopaedic Institute in Saint Petersburg, FL is seeking a Referral and Authorization Coordinator to accurately obtain referrals and authorizations, ensuring patients are approved for the physician, the date of service, and all anticipated services.

You will contact physician offices and payers, verify benefits, document authorizations, and collaborate with the Billing team to resolve denied claims, while delivering excellent patient service in a fast-paced medical environment.

Qualifications

• High school diploma required.
• Minimum 2 years of medical experience.
• Strong customer service and communication skills.
• Ability to multi-task and handle high call volumes.
• Accurate data entry skills.

Responsibilities

• Coordinate with PCPs and insurance to obtain referrals before the appointment.
• Ensure authorizations are documented in the system.
• Advise patients of potential issues obtaining authorization prior to appointment.
• Coordinate with Billing/Collections to obtain authorizations on denied claims.
• Coordinate with Benefit Verification to confirm benefits when problems occur.
• Use insurance portals (Availity, Humana Military/Tricare, United Healthcare) to obtain referrals/authorizations.
• All other duties as assigned.

Skills

Customer service

Communication skills

Data entry

Multitasking

Phone handling

Education

High school diploma

Tools

Availity

Humana Military (Tricare)

United Healthcare

Job description

Position Summary

Responsible for accurately and efficiently obtaining and documenting all referrals and authorizations. Ensures all patients are authorized for the physician, the date of service and all anticipated services. Referrals and Authorizations are obtained by contacting physician’s offices, insurance companies, and/or the patient.

Key Responsibilities

• Coordinate with appropriate primary care physicians and/or insurance companies to obtain referrals for office visits prior to the patient’s scheduled appointment.
• Ensure all authorizations are properly documented in the system.
• Advise patients of any potential problems concerning obtaining authorization prior to the scheduled appointment.
• Coordinate with the Billing/Collections department to research and obtain authorizations on previously denied claims.
• Coordinate with the Benefit Verification Rep to confirm benefits when problems occur.
• Utilize insurance websites (Availity, Humana Military (Tricare),United Healthcare, etc.) to obtain referrals/authorizations
• All other duties as assigned

Qualifications

• Candidate must be a high school graduate.
• 2 or more years of experience in a medical environment.
• Excellent customer service and communication skills.
• Able to multi-task and handle high call volumes.
• Excellent Data entry Skills

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.