Job description

Summary

This position is responsible for servicing the needs of patients by receiving phone calls from both members and referrals from providers to facilitate the authorization and coordination of referrals utilizing pre-approved screening criteria in compliance with contracted Client's requirements.

Essential Duties and Responsibilities.

• Receives phone calls and faxed referral requests from providers.
• Verifies member eligibility and benefits. Inputs all referral requests including ICD-10 and CPT codes into system accurately for electronically generated authorization tracking. Provides referral authorization to external providers per UM Departmental Policy and Procedures and specific contracted Client's process.
• Requests submission of appropriate medical records according to established criteria for requested service(s).
• Issues authorization within appropriate timeframe for routine, urgent and emergent requests.
• Appropriately forwards all referral requests to the next level of review.
• Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.
• Coordinates approved services with Home Health Providers, Plan discharge Planners and Plan Members as delegated or required by Plan.
• Is resource person for PCP to refer to network specialist(s).
• Compiles monthly departmental statistics.
• Distributes correspondence and other information to the appropriate parties or departments.
• Maintains appropriate logs, records, and reports as established by Utilization Department.
• Documents and communicates areas of concern to supervisor.
• Identifies providers who are problematic with plan requirements.
• Adheres to company HIPAA policies and procedures.
• Ensures integrity of data entry is accurate.

Education and/or Experience

• High school diploma or general education degree (GED);
• Healthcare experience in an Health Care Management, HMO, MCO, environment is a must
• Two years of UM healthcare management, and/or training; or equivalent combination of education and experience.
• Ability to speak fluent English and Spanish strongly required.
• Ability to communicate effectively and accurately over the telephone.
• Must have good customer service skills
• Ability to use cross reference guidelines
• Medical terminology skills

Health System One (HS1 Medical Management, Inc.) is an equal opportunity Employer.

Job Type: Full-time

Pay: From $17.50 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• Monday to Friday

COVID-19 considerations:
We are following appropriate CDC guidelines.

Ability to commute/relocate:

• Fort Lauderdale, FL 33316: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Insurance verification: 1 year (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: In person

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