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Insurance Authorization Specialist-Medical Necessity

Company: Jupiter Medical Center
Location: Jupiter
Posted on: May 25, 2023

Job Description:

Job Description

Jupiter Medical Center is reimagining how to restore the community's health and wellness. Award-winning physicians, world-class partnerships and innovative techniques and technology enable Jupiter Medical Center to provide a broad range of services with specialty concentrations in cardiology, oncology, imaging, orthopedics and spine, digestive health, emergency services, lung and thoracic, women's health, weight management and men's health. Our medical center consistently performs in the top 10 percent of hospitals for patient quality and satisfaction and has earned the highest rating in the region for quality of care.

The Insurance Authorization Specialist- Medical Necessity will be responsible for delivering a dynamic customer experience to all customers and demonstrate a strong commitment to service excellence.

The Medical Necessity Specialist is responsible for verifying health insurance information, running medical necessity for scheduled outpatient elective services, following up with physician offices when medical necessity fails, and appropriately documenting said information in STAR.

  • Utilizes electronic scheduling/registration/financial systems, payer's websites, and recorded calls to validate health coverage and benefits in processing approval for medical services.
  • Maintains proper documentation in all systems.
  • Works closely with Managed Care and understands health insurances rule sets, manuals, and contract language.
  • Contact patient's insurance company to verify coverage.
  • Determines medical necessity for services using medical criteria software.
  • Review and verify all insurance plans and confirm patient's eligibility and benefits.
  • Document findings and all pertinent information in the notes section of the patient's record and appointment notes in a thorough and clear manner.
  • Provides documentation upon request from insurance companies.
  • Contacts physician's office to get revised orders as needed.
  • Works well in a team environment to accomplish common tasks to solve problems and enhance the smooth and efficient flow of the practice.
    • Answer's telephone, responds to questions, directs calls, and documents messages
    • Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as need arises.
    • Develops and promotes the use of effective methods of communicating with physicians, managers, peers, trainees, and staff on a regular basis.
    • Verifies physician written orders are active, and certification of medical necessity and or detailed written order is in place.
    • Maintains the confidentially of patient's records and any related work.
    • Performs other duties as assigned.


      • High school graduate or equivalent
      • Associate Degree and/or completion of a relevant formal certifcaton programpreferred
      • Certification/Licenses: Current CPC, CCS, CCA, COC, CRC, RHIA and/or RHIT required or obtained within six months of hire date.
      • Enthusiastic, friendly, patient focused customer service skills.
      • Exemplary communication skills, written and verbalmust be comfortable speaking to patients via phone and successfully communicate pertinent information.
      • Professional, effective communication skills required to contact insurance companies to obtain insurance authorizations and physician offices for additional information, as necessary.
      • Must be a team player with ability to collaborate interdepartmentally and with clinical staff.
      • Capacity to multi-task with computer programs while providing patients the highest level of care and attention.
      • Works well in a team environment to accomplish common tasks to solve problems and enhance the smooth and efficient flow of the department.
      • Minimum of 2 year's experience with hospital insurance plans including Medicare, Medicaid, HMO's and PPO's.
      • CPT and ICD-10 medical necessity coding experience.
      • Excellent typing and computer skills.
      • Familiarity with area managed care plans and contractual terms.
      • Ability to self-direct and exercise independent judgment in situations requiring follow-up and discussions with clinical staff and/or other areas of Patient Access to ensure completion of required authorizations/approvals for payment services and enhanced customer service.
      • 2-3 years of specialized training in a health care setting with demonstrated knowledge of insurance verification, authorization and pre-certification process preferred.
      • Familiarty with medical terminology.


Keywords: Jupiter Medical Center, Jupiter , Insurance Authorization Specialist-Medical Necessity, Healthcare , Jupiter, Florida

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