Authorization & Scheduling Specialist

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, November 21st from 9:30 AM to 1:30 PM at The Villages Health Administrative Office (6503 Powell Road, The Villages, FL 32163) – RSVP’s are encouraged through Eventbrite at https://bit.ly/4jL7pip
  
  

Responsibilities:

A non-exempt position, responsible for covering areas of the department such as surgery scheduling, communications between patients and medical providers (liaison), and authorizations. This position is responsible for obtaining authorizations for medications, injections, surgeries and procedures, scheduling appointments, taking payments, and calculating out of pocket costs based on insurance coverage.

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.
• Acts as a liaison between patients, their families, providers, facilities, and the clinical team to ensure appropriate and efficient patient navigation and care.
• 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. This includes processing denials and appeals and ensuring all authorizations and referrals are in place.
• 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.
• Effectively address inventory concerns by keeping open communication with the purchasing team, including relaying delays of shipments and backorders to patients and providers. Identify and label medications as required including knowledge of storage requirements.
• Organize information in Microsoft Excel for use in tracking authorization status.
• Schedules patient for hospital or post-surgical follow-ups within established guidelines, to include but not limited to, creating new patient records in the Electronic Medical Record (EMR), updating patient information in EMR, providing new patient forms via DASH link
• Monitor patient appointments, ensuring appointments are kept.
• Other duties as assigned.

Education/Experience Requirements:

• High school diploma required.
• One year of insurance benefits and authorization experience required.
• Three to five years of previous experience in authorization of medical procedures or medications preferred.
• Certified Medical Assistant certification or Registered Pharmacy Technician certification preferred
• 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.
• Ability to manage heavy workload
  
  

Salary is commensurate with experience.

Questions? Contact us at recruitment@thevillageshealth.com

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