Job Description

Insurance Authorization Coordinator

Nemours is seeking an Insurance Authorization Coordinator in Jacksonville, FL. The Insurance Authorization Coordinator I is responsible for obtaining authorizations for hospital?based and/or physician?based services.

Essential Functions

• Authorization Coordination: Request and obtain preauthorization for assigned specialties and cover other workflows including workqueue items. Submit required documentation and follow up to ensure timely approvals.
• Ensure requests for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements, following all documentation requirements.
• Insurance Verification: Verify patient insurance coverage, eligibility, demographics and benefits to determine if prior authorization is required and to collect patient responsibility.
• Policy Knowledge: Stay updated with insurance policies, guidelines and procedures related to authorization and reimbursement processes.
• Process appointment or appointment add?ons, changes to previously scheduled services, date changes and service changes needing immediate review.
• Follow administrative review process if a service does not have an insurance authorization outside of the departments standard timeframe.
• Communication: Inform patients, families, and healthcare professionals of status of authorization requests, answer questions and ensure smooth process.
• Promptly review clinical documentation for necessary information to submit to the payer.
• Documentation and Record?Keeping: Maintain accurate and detailed records of authorization requests, approvals, denials and related correspondence.
• Collaboration: Work with healthcare providers, physicians, central office and other departments that impact authorization and reimbursement.
• Problem?solving: Identify and address barriers or challenges during the authorization process, including appeals and alternative solutions.
• Attend daily departmental huddles to report payer issues, workflow barriers and non?reimbursable risks.
• Organized, team?oriented, problem?solving, and able to seek assistance when needed.
• Provide excellent, empathetic, and knowledgeable customer service to internal and external customers.
• Compliance: Adhere to laws, regulations and privacy guidelines when handling patient information and insurance documentation.

Requirements

• High School Diploma
• 6 months to 2 years authorization experience

About Nemours Childrens Health

Nemours Childrens Health is an internationally recognized childrens health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state?of?the?art childrens hospitalsNemours Childrens Hospital, Delaware and Nemours Childrens Hospital, Florida. Our pediatric network includes 80 primary?urgent?and?specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion. We are committed to prevention, community partnership, and innovative health care.

Inclusion and belonging guide our growth and strategy. We are looking for individuals who are passionate about and committed to providing culturally relevant care, reducing health disparities, and building an inclusive environment.

Learn more about Nemours Childrens and how we go well beyond medicine at

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