Insurance Authorization Specialist - Pain Management

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education: High School Graduate or Equivalent

Qualifications:

·         Enthusiastic, friendly, patient focused customer service skills.

·         Exemplary communication skills, written and verbal – must be comfortable speaking to patients via phone and successfully communicate pertinent information.

·         Professional, effective communication skills required to contact insurance companies to obtain insurance authorizations and physician offices for additional information, as necessary.

·         Must be a team player with ability to collaborate interdepartmentally and with clinical staff.

·         Capacity to multi-task with computer programs while providing patients the highest level of care and attention.

·          Works well in a team environment to accomplish common tasks to solve problems and enhance the smooth and efficient flow of the department.

·          Ability to leverage insurance company sites, where possible, to expedite, authorization process.

Experience:

• Minimum of 2 years’ experience with medical group insurance plans including Medicare, Medicaid, HMO's and PPO's.
• Excellent typing and computer skills.
• Familiarity with area managed care plans and contractual terms.
• Epic experience preferred.
• Pain management authorization experience preferred.
• Ability to self-direct and exercise independent judgment in situations requiring follow-up and discussions with clinical staff and/or other areas of Patient Access to ensure completion of required authorizations/approvals for payment services and enhanced customer service.
• 2-3 years of specialized training in a health care setting with demonstrated knowledge of insurance verification, authorization and pre-certification process preferred.
• Familiarity with medical terminology.

Position Summary:

The Insurance Authorization Specialist will be responsible for delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence.

The Insurance Authorization Specialist is responsible for verifying health insurance information and obtaining authorizations, pre-certifications, and/or referrals for inpatient, observation, and scheduled outpatient elective services.

• Utilizes electronic scheduling/registration/financial systems, payer’s websites, and recorded calls to validate health coverage and benefits in processing approval for medical services.
• Maintains proper documentation in all systems.
• Works closely with Managed Care and understands health insurances rule sets, manuals, and contract language.
• Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted prior authorizations.

• Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations.
• Determines medical necessity for services using medical criteria software.
• Review and verify all insurance plans and confirm patient's eligibility and benefits.
• Document findings and all pertinent information in the notes section of the patient’s record and appointment notes in a thorough and clear manner.
• Provides documentation upon request from insurance companies.
• Works well in a team environment to accomplish common tasks to solve problems and enhance the smooth and efficient flow of the practice.
• Answers telephone, responds to questions, directs calls, and documents messages.
• Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as need arises.
• Develops and promotes the use of effective methods of communicating with physicians, managers, peers, trainees, and staff on a regular basis.
• Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity and or detailed written order is in place.
• Maintains the confidentially of patient’s records and any related work.
• Performs other duties as assigned.

Team Member Competencies
Establishing Relationships
Builds effective networks, working relationships, and alliances in order to collaborate effectively within department and organization. Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.
Peer Support
Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively within the team.
Inspiring and Motivating Others
Fosters commitment and cohesiveness by facilitating cooperation and working as a team within the organization toward goal accomplishments. Work well with others, build consensus, and ensure cooperation to complete tasks and positive workflow.
Demonstrating Emotional Intelligence
Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.
Acting with Integrity
Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations. Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments. Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.
Being a Champion for Change and Innovation
Supports people in their efforts to try new things. Things creatively, generates novel and valuable ideas and uses these ideas to develop new or improved processes. Accepts new ways of doing things and adapts to change.
Communicating Effectively
Speaks and writes clearly, conveys information in a concise, organized, and logical manner. Is adept at tailoring the message to fit the interests and needs of the audience. Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and organization.
Promoting Diversity and Inclusion
Treats all people with dignity and respect. Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics. Challenge’s bias and intolerance. Develops all-inclusive groups in the realms of social interaction and communication. Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.

Physical Requirements:

• Ability to sit, stand, bend for long periods of time. Occasional shoulder reaches overhead p to 2 per minutes. Occasional shoulder forward reaches 16-17 inches away from body up to 2 per minute. Occasional grip with force up to 10lbs per 10 seconds. Occasional forward bending of torso 20-30 degrees hold for 1 minute. Occasional sitting up to 2 hours. Keying for up 7 hours with periods of rest. Occasional standing and or walking up to 1 hour. Occasional lift up to 5lbs from floor to waist. Occasional lift up to 5lbs from waist to above shoulder height. Occasional lift and carry up to 5 lbs over a distance of 25 feet.

Threshold Requirements:

• These threshold requirements are required and completed yearly basis.
  • Annual Joint Commission mandatory education requirements, in-service and health requirements including attendance at new employee orientation.
  • TB/PPD Surveillance Program
  • Maintenance of required professional licensing and/or certification(s).