Insurance Specialist in Jacksonville, FL at Pride Health

Date Posted: 5/30/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Experience:
    Not Specified
  • Date Posted:
    5/30/2019

Job Description

Pride Health has an opening for a Medical Insurance Specialist to join a large healthcare facility in Jacksonville, FL.  Interested individuals, apply today!

Responsibilities:

  • Responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments.
  • Obtaining prior authorizations
  • Responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department.
  • Process of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts.
  • This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations

Requirements:

  • High School Diploma or GED required
  • Minimum Experience: 2+ years of relevant experience required OR Bachelor’s Degree required. 
  • Position requires general knowledge of healthcare terminology and CPT-ICD10 codes.
  • Basic knowledge of and experience in insurance verification is preferred.
  • Ability to work in a complex environment with varying points of view.
  • Knowledge of and experience using an Epic RC/EMR system is preferred.

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