Authorization Representative (Pain Management procedure specific) Interventional Spine and Pain Institute - 2.7 Palm Bay, FL Job Details Full-time $19.07 - $22.36 an hour 3 days ago Benefits Paid time off Qualifications Record keeping Customer communication Managed care Customer service Medical office experience HIPAA Medical coding guidelines Medical administrative support Policy verification in claims processing Health information regulatory compliance Patient interaction Health information management Clinical confidentiality policies Clinical documentation standards Managing patient records Full Job Description Interventional Spine and Pain Institute is seeking a highly motivated and detail-oriented Medical Insurance Authorization Specialist to join our team, working out of our Palm Bay office location. This role is integral in managing large case in-office procedures by securing insurance authorizations, verifying coverage, and ensuring compliance with healthcare policies. The ideal candidate will excel in navigating complex insurance requirements, communicating effectively with providers and patients, and maintaining strict confidentiality of medical records. If you thrive in a fast-paced environment and are passionate about facilitating seamless healthcare delivery, this opportunity is perfect for you! Responsibilities Obtain prior authorization from insurance companies for large case procedures (SI Joint Fusion, Kyphoplasty, Spinal Cord Stimulator trials, etc), ensuring all necessary documentation is complete and accurate. Verify patient insurance coverage, benefits, and eligibility using electronic health records (EHR) systems and other tools. Collaborate with healthcare providers to gather required clinical information, CPT/ICD codes, and supporting documentation. Maintain thorough records of authorization requests, approvals, denials, and appeals in compliance with HIPAA regulations. Communicate proactively with managed care organizations and insurance carriers to expedite approvals and resolve issues promptly. Ensure adherence to medical terminology standards, clinical confidentiality policies, and health insurance policy guidelines throughout the authorization process. Utilize Microsoft Office applications to document processes, generate reports, and update patient records efficiently. Frequent follow up throughout the authorization process, ensuring successful securing of authorization for correct CPT codes as they pertain to procedure type Accurately carries out the responsibility for verifying patient insurance coverages and obtaining authorizations for various visit types Coordinates psych evaluations with patient and partnered physician offices, seeing the process through from completion to resolution Responsible for entering data into EMR in an accurate manner, attaching authorization to patient chart in correct area, updating patient insurance benefit information and verifying that existing information is accurate Demonstrates proficiency in working with insurance companies and has extensive knowledge of different types of coverages, policies and insurance portals Coordinates communication with respective vendors, keeping them apprised of appointment dates and status, when booked Assists with coordinating and attaining medical clearances for specific visit types, ensuring all labs are scanned into patient chart prior to pre-operative office visits. Must have clear and strong understanding if in-network and out-of- network benefits and how they work with payers along with deductibles, co-pays and co-insurance. Proficient in obtaining outside medical records for chart, but also in fulfilling and processing medical record requests that flow out of the organization. Demonstrates excellent communication skills with patients throughout the process of scheduling and obtaining authorization. Possesses excellent multitasking skills, with the ability to work on multiple projects at once. Is very detail-oriented and organized, and maintains accurate patient insurance records. Is proficient in the use of Availity and insurance-specific portals to accurately verify insurance coverage and patient responsibility, but also procure authorizations. Also, knows when it is appropriate to use Availity, the insurance portal, or call the patient. Other administrative duties as assigned. Requirements Proven experience in a medical office setting with familiarity in medical records management and office procedures. Strong knowledge of health insurance policies, managed care processes, and insurance verification protocols. Proficiency in medical coding including CPT/ICD coding systems and principles. Experience with electronic health records (EHR) or electronic medical records (EMR) management systems. Excellent customer service skills with the ability to communicate clearly and professionally with patients, providers, and insurance representatives. Knowledge of clinical confidentiality policies such as HIPAA to ensure patient privacy at all times. Ability to interpret health insurance policies accurately and navigate complex authorization requirements efficiently. Familiarity with medical billing processes, medical terminology, and healthcare documentation standards is highly desirable.

Pay:

$19.07 - $22.36 per hour

Benefits:

Paid time off Application Question(s): What EMRs have you used in an authorizations capacity (please name them)? What is your desired hourly pay rate (this must be a number or range)?

Experience:

procedure authorizations: 2 years (Required)

Work Location:

In person