Referral & Authorization Coordinator

KIDZ Medical Services; West Palm Beach (FL); On-site; USD 42,000 - 54,000; Full time

Job summary

KIDZ Medical Services in West Palm Beach, FL seeks an energetic, dependable Authorization Specialist to complete authorizations and referrals for our medical services. You will verify insurance coverage, review patient medical histories, and coordinate with providers to ensure timely prior authorization for appointments and procedures.

You will interact with healthcare providers, insurance companies, and patients to obtain authorization information and communicate any potential delays or

Qualifications

• Completes authorizations and referrals for medical services.
• Verifies insurance coverage and reviews patient medical history.
• Monitors schedule for add-on patients and ensures prior authorization.

Responsibilities

• Verifies information provided by referring physicians and verifies insurance coverage.
• Analyze patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization.
• Ensure patients are eligible for services and that insurance benefits are accurate.
• Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions.
• Notify providers of potential coverage options.
• Complete billing documentation.
• Monitors the schedule for add-on patients to ensure prior authorization is obtained before appointments or procedures.
• Remain informed about healthcare industry regulations, trends and insurance policies.

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Clerical KIDZ West Palm Beach 206, West Palm Beach, FL, US

3 days ago Requisition ID: 1553

We are looking for a energetic, hard-working, dependable, multi-tasking Medical Insurance Authorization specialists who are passionate about helping others and making a difference.

SUMMARY: The Authorization Specialist completes authorizations and referrals for our medical services. In addition to reviewing the medical history of potential patients, verifies information provided by referring physicians and verifies insurance coverage. Also monitors the schedule for add-on patients, ensuring there are no conflicts we have the prior authorization needed to move forward with appointment or procedure.

DUTIES AND RESPONSIBILITIES:

• Verifies information provided by referring physicians and verifies insurance coverage.
  • Analyze patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization
  • Ensure patients are eligible for services and that insurance benefits are accurate
  • Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
  • Notify providers of potential coverage options
  • Communicate with patients about the authorization process and any potential delays or financial implications.
  • May suggest formulary/cheaper alternatives for expensive drugs.
  • May investigate any serious drug interactions with the requested drug.
• Completes authorizations and referrals for our medical services, including appointments and procedures.
  • Input new patient information and update information in our system
  • Compile and submit detailed authorization requests to insurance companies, including all necessary documentation
  • Research and resolve any issues or discrepancies related to authorization requests
  • Monitor and follow up on authorization requests to ensure timely processing
  • Investigate insurance denials and resubmit requests or appeal when necessary.
  • Complete billing documentation
• Monitors the schedule for add-on patients, ensuring no conflicts, and we have required prior authorization to move forward with appointment or procedure.
• Remain informed about healthcare industry regulations, trends and insurance policies
• Assist with other clerical tasks as needed and perform other related duties as assigned by management.

JOB TYPE / WORK SCHEDULE:

• This is a full-time position, in-office position
• Standard office hours, Monday - Friday 8:00 AM - 4:30 PM

Competitive pay and full benefits package, including 401(k), health, dental, vision, life, and disability insurance.