Centralized Authorization Team

POSITION SUMMARY:   

A centralized authorization team oversees both patient referrals and authorization processes in a healthcare setting. Key responsibilities include obtaining pre-authorizations from insurance companies, managing referral documentation, and ensuring that patients are scheduled appropriately with specialists or for diagnostic services. They function as liaisons between healthcare providers, insurance companies, and patients to ensure smooth coordination of care. This role typically requires knowledge of medical terminology, insurance verification processes, and excellent communication skills, with experience in healthcare or customer service settings being highly beneficial. 

ESSENTIAL RESPONSIBILITIES: 

• Review and process referral requests from physicians or healthcare providers.
• Ensure all necessary patient information and documentation are included.
• Obtain pre-authorizations and verify insurance coverage.
• Communicate with healthcare providers, insurance companies, and patients.
• Monitor and track the status of authorization requests, ensuring timely approvals.
• Maintain up-to-date and organized records for future reference and auditing. 
• Accurately document all referral and authorization activity in patient records.
• Provide guidance and information to patients regarding their referrals and authorization processes. 
• Responds to and refers to incoming telephone calls. Communicate referral details to patients, including instructions and expectations. 
• Provide patient education and support throughout the referral process. 
• Stays current with insurance requirements for referrals, authorizations, imaging, procedures etc.
• Ensure that services requiring authorization are covered under the patient’s insurance plan.
• Stay informed about changes in insurance policies and coverage guidelines.
• Acts as liaison between hospitals, physicians, patients, and other referral sources.
• Help train and assist other Referral Specialists.
• Troubleshoot and resolve issues related to referral and authorization denials.
• Follow up on any delays or discrepancies to expedite services for patients. 
• Consistently displays a positive attitude and a personal commitment to excellence.
• Attends all department meetings and clinic required meetings.
• Ensure compliance with HIPAA and other healthcare regulations related to patient confidentiality and insurance authorizations. 

Competencies: 

• Patient Centered
• Effective communication, organizational and interpersonal skills
• Ethical Conduct
• Personal Effectiveness
• Thoroughness
• Time Management

Required Education and Experience: 

• This role typically requires 1-3 years of experience, preferably in a medical office or healthcare environment, and proficiency with electronic medical records (EMR) and scheduling systems. Strong organizational, communication, and customer service skills are essential, as the specialist often interacts with multiple stakeholders to facilitate patient care.
• High School Diploma or GED.
• Graduation from an accredited school of nursing or medical assistant school or program. 
• Possession of a Florida RN, LPN license or an active MA certification or registration.
• Current American Heart Association recognized Basic Life Support (BLS) certification.
• At least one year of experience in outpatient nursing.

Physical Demands: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  

While performing the duties of this job, the employee is regularly required to talk or listen. This position on occasion will require you to lift objects up to 15lbs. Strong verbal and written communication skills required. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The ability to exercise good judgment and positively influences and leads others, including handling confrontations with poise and efficiency. Repetitive motion of the upper body required for extended use of computer.  

Position Type/Expected Hours of Work: 

This is a full-time position in an outpatient medical business office setting. The schedule for this position is Monday through Friday, 8am to 5pm. Based on business need, the ability to work a flexible schedule, including some overtime as approved in advance. 

Travel: 

This position may require travel for training purposes. 

Work Environment: 

This position requires regular and reliable on-site attendance.  

Other Duties: 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. 

EEO Statement: 

White-Wilson Medical Center, P.A. and affiliates are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.