Medical Authorization Specialist

BEST DOCTORS INSURANCE SERVICES LLC; Florida; Vor Ort; USD 42.000 - 68.000; Vollzeit

Zusammenfassung

BEST DOCTORS INSURANCE SERVICES LLC is seeking a Medical Coordinator in Guayaquil to review requests for medical service evaluations and authorizations. The role requires independent work, strong policy knowledge, and interaction with members, agents, or providers.

The candidate should be adept at handling ICD-10 and coding guidelines, explaining benefits by phone, email, and Live Chat, and maintaining excellent customer service.

Qualifikationen

• Desire to be service oriented, prompt and courteous; positive, customer-focused attitude.
• Ability to express clearly in English and Spanish, both verbally and in writing.
• Able to cope with stressful situations with composure.
• Special attention to detail and self-motivation.
• Excellent follow-up and organizational capabilities.
• Ability to manage a balanced workload and prioritize accordingly.
• Ability to work well independently and as part of a team.
• Judgment and discretion in approving cases impacting company finances.
• Proficient with computers and office equipment.

Aufgaben

• Acts autonomously and requests medical information for authorization of services.
• Explains benefits via phone, email and Live Chat; requests necessary documentation.
• Monitors Precert inbox and responds within 24–48 hours.
• Evaluates medical fees using UCR schedules and steering guidelines; negotiates with providers.
• Maintains service levels with prompt email responses and accurate authorizations.
• Works independently or with a team; makes judicious decisions as needed.
• Keeps attention to detail and multi-tasks effectively.
• Performs after-hours on-call schedule as required.
• Follows up on pending cases and issues authorizations or denials as needed.

Kenntnisse

Customer-focused attitude

English and Spanish communication

Attention to detail

Teamwork

Judgment & discretion

MS Office proficiency

Handling high volume calls/emails

Ausbildung

College education

Tools

MS Office

Jobbeschreibung

BEST DOCTORS INSURANCE SERVICES LLC is seeking a Medical Coordinator in Guayaquil to review requests for medical service evaluations and authorizations. The role requires independent work, strong policy knowledge, and interaction with members, agents, or providers.

The candidate should be adept at handling ICD-10 and coding guidelines, explaining benefits by phone, email, and Live Chat, and maintaining excellent customer service.