Insurance Authorization Coordinator I (Pediatric Finance)

Nemours in; Pensacola (FL); On-site; USD 25,000 - 36,000; Full time

Job summary

Nemours Children?s Health is seeking an Insurance Authorization Coordinator I (Finance) to obtain preauthorizations for hospital- and physician-based services. You will verify insurance coverage, eligibility, benefits and patient financial responsibility while ensuring compliance with payer requirements.

The role involves coordinating authorizations, documenting requests, communicating with patients and providers, and collaborating with the Central Business Office and other teams to resolve

Qualifications

• One year of specialized training beyond high school.
• Minimum of 6 months Insurance Authorization experience required.

Responsibilities

• Authorization coordination: request and obtain preauthorization for assigned specialties and cover for other workflows.
• Verify insurance coverage, eligibility, demographics, benefits and financial responsibility to determine if prior authorization is required.
• Stay up to date with insurance policies, guidelines, and procedures related to authorization and reimbursement processes.
• Process appointment changes and add-ons, changes to scheduled services, or impactful service changes for immediate review.
• Communicate with patients, families, and healthcare professionals about status of authorization requests.
• Review clinical documentation to submit to the payer along with authorization requests.
• Maintain accurate records of authorization requests, approvals, denials, and related correspondence.
• Collaborate with healthcare providers, physicians, clinical staff and other departments involved in obtaining authorizations.
• Identify and address barriers; resolve denials or appeals when needed.
• Participate in daily departmental huddles to report payer issues and workflow barriers.
• Be organized, work well in a virtual team, and seek assistance when needed.
• Build and maintain professional relationships with specialty departments and provide empathetic customer service.
• Adhere to privacy laws and organizational policies for authorization processes.

Education

One year of specialized training beyond high school

Job description

Nemours Children?s Health is seeking an Insurance Authorization Coordinator I (Finance) to obtain preauthorizations for hospital- and physician-based services. You will verify insurance coverage, eligibility, benefits and patient financial responsibility while ensuring compliance with payer requirements.

The role involves coordinating authorizations, documenting requests, communicating with patients and providers, and collaborating with the Central Business Office and other teams to resolve