Authorization Specialist HFMG - Ortho Surgery Spine

Health First; Melbourne (FL); On-site; USD 25,000 - 39,000; Full time

Job summary

Health First in Melbourne, FL is seeking an Authorization Specialist to verify insurance eligibility, obtain benefits, and secure pre-certifications for outpatient services. The role requires coordinating with insurers, clinicians, and patients, ensuring timely authorizations in line with Health First policies.

The candidate should have a high school diploma, 2 years of experience in healthcare insurance authorizations or CPT/ICD-10 background, and proficiency in Microsoft Office.

Qualifications

• Education: High School Diploma or equivalent.
• Two years’ healthcare insurance authorizations OR two years’ clinical healthcare with CPT and ICD-10 experience.
• L icensure: None
• Certification: None
• Proficient in Microsoft Office – Outlook, Word, Excel, PowerPoint.
• Ability to operate and stay organized with multiple screens in a call center setting.
• Understanding CPT and ICD-10 and health insurance concepts.

Responsibilities

• Verify insurance benefits for customers.
• Notify customers of deductibles and co-insurance requirements.
• Call insurance companies to follow up on authorization status.
• Explore other payment options with customers when needed.
• Process referrals and submit medical records for prior authorization.
• Manage correspondence with insurers, physicians, and patients.
• Handle emails, faxes, and calls while ensuring HIPAA compliance.

Skills

Medical terminology

Insurance knowledge

Organization skills

HIPAA compliance understanding

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

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.

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 Accountabilities

• 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.

Work Experience

MINIMUM QUALIFICATIONS

• Education: High School Diploma or equivalent
• Work Experience: Any one of the following:
• Two (2) years’ performing Healthcare insurance authorizations OR
• Two (2) years’ in clinical healthcare with background with CPT and ICD-10 codes.
• Licensure: None
• Certification: None
• Skills/Knowledge/Abilities:
• Proficient in Microsoft Office – Outlook, Word, Excel, PowerPoint.
• Ability to operate and stay organized when using multiple computer screens and website windows and function effectively in a call center environment.
• 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.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

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.

Schedule : Full-Time

Shift Times : 8:00 AM - 5:00 PM

Paygrade : PG-27