Job Description
About The Villages Health The Villages Health is a patient-centered primary care driven, multi-specialty medical group with over 800 team members. Our unique care model gives us both the time and resources to truly care for our patients, along with a company culture that supports a healthy work-life balance for our team members. Our purpose, mission and vision is to empower Villagers and the surrounding communities to live out their dreams by keeping them healthy and healing them quickly. Together, we are changing the way healthcare is delivered and are making a positive difference in the lives of our patients and the communities we serve. In doing so, The Villages Health is creating America’s Healthiest Hometown.
Our Full-time Benefits
Medical, Dental & Vision Insurance | Matching HSA & 401k | PTO & Paid Holidays | The Villages Charter School Eligibility | & much more!
Hiring Event Please bring your resume and join us:
- Friday, June 13 th from 9:30 AM to 1:30 PM at The Villages Health Administrative Office (6503 Powell Road, The Villages, FL 32163).
Responsibilities: This position is responsible for obtaining authorizations for medications, injections & contraceptive devices, scheduling appointments, taking payments, and calculating out of pocket costs based on insurance coverage. These services provide a smooth process for our patients by using “buy and bill” or specialty pharmacy.
Duties and Responsibilities may include, but are not limited to:
- Must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, and collaborative.
- Demonstrate high proficiency of general medical office procedures, including HIPAA regulations.
- Request, track, and obtain authorizations from insurance carriers within time allotted for medical treatment.
- Review details and expectations about the authorization and scheduling process with patients.
- Contact insurance carriers to verify patient’s insurance eligibility, benefits, and authorization requirements. Must be able to use multiple methods of communication including phone calls, faxing, and portal access to obtain information as required.
- Use knowledge of procedure codes (CPT) and diagnosis codes (ICD-10) to request and receive authorizations.
- Review clinical documentation to ensure it supports insurance requirements for prior authorization approval. Must be able to effectively communicate any changes in requirements or updates from insurances to the clinical teams and providers.
- Demonstrate and apply knowledge of medical terminology to be able to review and answer questions based on information from patient charts including physician office notes, medication orders, procedure documentation, and imaging reports.
- Ensure that authorizations are addressed in a timely manner and that clinical teams are notified of any delays in patient care.
- Be the main point of contact for patients, providers, clinical staff, insurance companies, and pharmacies for authorization and scheduling status.
- Clearly document all communications and contacts with providers and personnel utilizing standard requirements, including proper format.
- Organize information in Microsoft Excel for use in tracking authorization status.
- Other duties as assigned
Education/Experience Requirements: - High school diploma required.
- Certified Medical Assistant certification or Registered Pharmacy Technician certification preferred.
- Previous experience in authorization of medical procedures or medications.
- One year of insurance benefits and authorization experience required
- Knowledge of the health care field and medical office protocols / procedures
- Knowledge of billing practices and clinic policies and procedures
- Must be able to communicate clearly, accurately, and professionally
- Must be able to review office visit notes, imaging reports, lab reports, and other clinical documentation for use in answering clinical questions
- Must be able to consistently demonstrate a high level of organization
- Must consistently demonstrate strong attention to detail
- Must have a background in medical terminology including knowledge of ICD-10, NDC, CPT, and HCPCS codes
- Experience with Microsoft Office (specifically Microsoft Excel) is required
Salary is commensurate with experience. Questions?Contact us at recruitment@thevillageshealth.com
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Job Tags
Holiday work, Full time,