MS/Prior Authorization Spec

Tallahassee Memorial HealthCare; Tallahassee (FL); On-site; USD 45,000 - 60,000; Full time

Job summary

Tallahassee Memorial HealthCare (TMH) is a private, nonprofit community-based healthcare system serving a 22-county region in North Florida and South Georgia. We offer a 772-bed acute care hospital with Level II Trauma Center, Primary Stroke Center, NICU, PICU, and top cancer, heart, vascular, orthopedic and surgery programs.

The role focuses on managing the prior authorization process, verifying coverage, maintaining documentation, and collaborating with clinicians to ensure timely patient

Qualifications

• High school diploma or equivalent required.
• Two years of relevant, job-related work experience.
• Preferred: vocational certificate or associate degree in healthcare, education, information science, or related field.

Responsibilities

• Manage the prior authorization process for medical procedures, treatments, and medications to ensure prompt approvals and smooth patient care.
• Manage prior authorizations.
• Maintain documents and records.
• Verify insurance coverage.
• Collaborate with healthcare providers, physicians, and clinical staff.
• Audit documents to ensure regulatory compliance.
• Demonstrate I CARE values (integrity, compassion, accountability, respect, excellence).
• Enhance a safe environment for colleagues, visitors, and patients.
• Perform miscellaneous duties.

Skills

Prior authorizations

Insurance verification

Multitasking

Attention to detail

Communication

Education

High school diploma or equivalent

Vocational certificate or associate degree (preferred)

Tools

Allscripts PM

Allscripts EHR

Job description

WHO WE ARE & WHAT WE DO

Tallahassee Memorial HealthCare (TMH) is a private, nonprofit community-based healthcare system that provides advanced care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community.

TMH is the region’s healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region’s only:

• Level II Trauma Center
• Primary Stroke Center
• Level III Neonatal Intensive Care
• Pediatric Intensive Care
• The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle.

Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices.

HOW YOU'LL MAKE AN IMPACT

Your Role:

• Manages the prior authorization process for medical procedures, treatments, and medications; uses a proactive approach to ensure prompt approvals and facilitate smooth patient care.
• Manages prior authorizations.
• Maintains documents and records.
• Verifies insurance coverage.
• Collaborates with healthcare providers, physicians, and clinical staff members.
• Audits documents to ensure regulatory compliance.
• Displays an understanding of diversity.
• Demonstrates integrity, compassion, accountability, respect, and excellence (I CARE values).
• Enhances and contributes to a safe environment for all colleagues, visitors, and patients.
• Performs miscellaneous duties.

Reports To:MS [Medicus Select]/Director Operations (JC: 820802).

Supervises:None.

WHAT YOU’LL NEED TO APPLY

Required Education: High school diploma or equivalent (e.g., certificate of high school equivalency).

Preferred Education: Vocational certificate or associate degree in a healthcare, education, information science, or related field.

Required Experience: Two (2) years of relevant, job-related work experience.

Preferred Experience:

• Two (2) years of experience with Allscripts Practice Management (PM) and Electronic Health Records (EHR) and/or in insurance, billing, and collections.
• Clinical background or experience in a medical setting.
• Knowledge of charges, payments, and collections.
• Knowledge of Allscripts.
• Ability to multi-task effectively.
• Very meticulous.

Required Certification/License/Registry: None.

Preferred Certification/License/Registry:None.

Tallahassee Memorial HealthCare is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.