Physician Practice Representative- Pediatric Hematology/Oncology Position Available In Palm Beach, Florida

SUMMARY:

Seeking a full-time (Monday

• Friday) Physician Practice Representative to join our busy pediatric hematology/oncology office on the campus of the Palm Beach Children’s Hospital at St.

Mary’s Medical Center. This position is responsible for performing day-to-day administrative functions with the primary focus on obtaining authorizations and referrals for procedures, testing, drugs and office visits. This position will also be responsible for insurance verification and scheduling patient appointments including new patient appointments and follow up visits. Must have the ability to multi-task and prioritize effectively in a high-paced environment. Inputs new patient information and updates information in our EMR system Analyzes 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 Notifies providers of potential coverage options Communicates with patients about the authorization process and any potential delays or financial implications. Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation Completes/obtains authorizations and referrals for services, including appointments, procedures, infusions, and medications Researches and resolves any issues or discrepancies related to authorization requests Monitors and follows up on authorization requests to ensure timely processing Investigates insurance denials and resubmit requests or appeals when necessary. Monitors schedule for potential issues Remains informed about healthcare industry regulations, trends and insurance policies Performs other related duties as assigned by management.

QUALIFICATIONS

High school diploma or general education degree (GED), or 2+ years related experience and/or training, or equivalent combination of education and experience.

Computer skills required:

Microsoft Outlook, Word, Excel and Adobe; Experience working with medical practice management software a plus.

Other skills required:

Experience working in a physician practice. Knowledge of medical terms and medical insurance Experience in requesting/submitting prior authorization for various diagnostic exams, prescriptions, etc. Professional demeanor and appearance. Strong interpersonal and communication skills. Meticulous attention to detail. Proficient in Microsoft Office Suite (Word, Excel, Outlook)

OTHER COMPETENCIES

Adaptability

• Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events. Attendance/Punctuality
• Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time. Customer Service
• Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. Dependability
• Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. Ethics
• Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values. Oral Communication
• Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. Organizational Support
• Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization’s goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity. Teamwork
• Balances team and individual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed. Written Communication
• Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.