MS/Prior Authorization Spec

Tallahassee Memorial HealthCare; Tallahassee (FL); On-site; USD 42,000 - 65,000; Full time

Job summary

Tallahassee Memorial HealthCare in Tallahassee seeks a detail-oriented Prior Authorization Specialist to manage the prior authorization process for procedures and medications, ensuring prompt approvals and smooth patient care.

You will verify insurance coverage, maintain records, collaborate with clinicians, audit documents for regulatory compliance, uphold I CARE values, and support a safe, diverse environment.

Qualifications

• High school diploma or equivalent is required.
• Preferred: Vocational certificate or associate degree in a healthcare, education, information science, or related field.
• Two years of relevant work experience.
• Preferred: Two years of experience with Allscripts PM and EHR; clinical background or billing/collections.
• Knowledge of Allscripts.
• Ability to multi-task effectively.
• Very meticulous.

Responsibilities

• 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 authorisations.
• 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.

Skills

Very meticulous

Multi-tasking

Education

High school diploma or equivalent

Vocational certificate or associate degree in healthcare, education, information science, or related field

Tools

Allscripts Practice Management

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 centres, six residency programmes 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 authorisations.
• 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.

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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.